Choosing a Doctor and a Hospital

Once you have learned you have cancer, the next step is to make sure you have the best possible medical care and treatment. Choosing your doctor and treatment center is one of the most important decisions you will make. There are many excellent cancer care centers throughout the United States, but how do you know where to look?

Here are some things to think about as you choose your doctor and hospital.

Determining cancer care quality

When you first learn about a cancer diagnosis, there are many things to think about. Most people with cancer are not experts on cancer treatment. You probably don't feel like you have the time, energy, or resources to figure out how to get "quality cancer care." You might need some help.

The doctor who found your cancer is the first person you should ask: "If you found out that you or someone you loved had this cancer, which doctor would you see for treatment?" In many cases, the doctor will go ahead and suggest another doctor even if you don't ask.

If your doctor isn't sure of your diagnosis, but thinks there's a chance you might have cancer, you can ask: "If you were in my place, which doctor would you see first?" Ask for at least 2 or 3 names, and find out what these doctors' specialties are. Find out if they practice at cancer treatment centers. Then later you can find out more about the treatment centers and the doctors.

To help you with this, the organizations listed here work with cancer treatment centers and can point you to centers that offer only the best in cancer care.

Commission on Cancer

The Commission on Cancer (CoC), a program of the American College of Surgeons, approves hospitals or facilities that have committed to provide the best in cancer diagnosis and treatment. Its list of approved facilities includes more than 1,400 cancer centers in the United States.

A good way to judge the quality of cancer care at a treatment facility is to find out if it has been approved by the CoC. If it has, you know it meets certain standards and offers a range of cancer care services. No matter its size or location, its ability to deliver quality cancer care is constantly being looked at by the CoC.

CoC-approved cancer programs are found in many different kinds of hospitals or facilities. They may be in major treatment centers, community hospitals, or other diagnostic and treatment centers. Approved programs must provide state-of-the-art diagnostic and treatment services. They have many different specialists available to treat patients, they take part in a cancer registry that collects all kinds of information on cancer, and they can give you information on clinical trials and new treatment options. CoC-approved cancer programs must also offer life-long follow-up care to people with cancer. This means that any problems, such as late side effects, recurrences, or new cancers, are found and treated as soon as possible.

To find a CoC-approved center near you, see the "Additional resources" section for contact information on the American College of Surgeons Commission on Cancer.

National Cancer Institute

The National Cancer Institute (NCI) is part of the US National Institutes for Health. The NCI is dedicated to better understanding, diagnosing, treating, and preventing cancer. Its goal is to support and enhance the quality of clinical cancer research. The NCI works with more than 60 cancer centers in the United States. It recognizes 3 levels of cancer treatment centers, ranging from a comprehensive cancer center to the more basic cancer treatment center. These centers are often housed at universities where research is done.

You can get a list of the NCI-designated Cancer Centers and read more about the NCI by visiting the NCI Web site at www.cancer.gov. You can learn more about your cancer and treatment options through the NCI Cancer Information Service, which is also available on their Web site. All of this information is free.

Children's Oncology Group

The Children's Oncology Group's mission is to cure and prevent childhood and adolescent cancer through scientific research and comprehensive care. More than 90% of children with cancer in the United States are treated at centers that are Children's Oncology Group (COG) members. COG has more than 200 affiliated centers that are linked to a university or children's hospital. To find a listing of COG institutions by state, go to their Web site at www.curesearch.org/resources/cog.aspx.

Choosing your doctor

Going through the process of choosing a doctor can take time. Many people are tempted to rush through this in order to start treatment sooner. Keep in mind, though, that most people with cancer will have enough time to be sure that they get the best care possible. Ask the doctor who found your cancer if you need to take action right away, or if you can take a short but safe amount of time to check out all your options.

Carefully choosing the doctor you need now (such as a good surgeon, radiologist, and/or oncologist) will pay off for years to come. Your relationship with this person will probably last through treatment into long-term follow-up care.

Decide what you want and need in a doctor

Before you start looking for a doctor, think about the qualities you want your doctor to have. A few ideas are listed below, but there may be others you want to add.

• Choose a doctor who has experience with your type of cancer. Studies show that doctors have better success treating a condition if they have a lot of experience with it.
• You will probably need a doctor who is part of your health plan (often called a preferred provider) and/or accepts your health insurance. Otherwise, you may have to pay for your health care yourself. (For more on this, call us for a copy of Health Insurance and Financial Assistance for the Cancer Patient or read it at www.cancer.org)
• Pick a doctor who has privileges (is able to practice) at a hospital that you are willing to use. Doctors can only send patients to hospitals where they have admitting privileges.
• Choose a doctor you feel comfortable with. Languages spoken, gender, ethnicity, and educational background may be important factors for you. You may also have strong feelings about personality and bedside manner. Some people want their doctors to have a business-like manner, while others value a doctor who can help with their emotional health as well as their medical needs. Many people whose illnesses require long-term treatment prefer a friendly relationship with their doctor.

Make a list of doctors who might be a good fit

One of the best ways to choose a doctor to treat your cancer is to get referrals from people you trust, like your primary care doctor. You might also try to speak with others in your area who have been treated for the type of cancer you have to see who treated them. Some hospitals and communities also have physician referral services available by phone or online. These allow you to learn more about the doctors in your area, such as their areas of expertise, medical certifications, office locations, languages spoken, and so on. You can find these referral services through many hospitals by calling their main number or visiting the hospital Web site. Or you can ask your primary care doctor about them.

If you are in a health plan, you can begin by checking their list of doctors. This is usually available online or by calling the member services hotline. You will still want to find out more about each doctor before you decide.

Call the doctors' offices and make appointments: The first visit

Once you've found doctors that seem like a good fit for you, call their offices and ask if they are on your health insurance plan and are taking new patients. You might also want to find out which hospitals they work in and have admitting privileges for.

The next step is to schedule appointments with a few doctors. Check with the doctors' offices and your insurance company to find out if this kind of visit is covered.

The most important question to ask them is how much experience they have in treating your type of cancer. If you are meeting with surgeons, find out how often they perform the type of surgery you need, how many of these surgeries they have performed before, and what their success rate is.

Along with finding out the doctor's medical experience and credentials, notice how comfortable you feel with him or her. One way to measure this is to ask yourself these questions after your appointment.

• Did the doctor give you a chance to ask questions?
• Did you feel the doctor was listening to you?
• Did the doctor seem comfortable answering your questions?
• Did the doctor talk to you in a way that you could understand?
• Did you feel the doctor respected you?
• Did the doctor ask your preferences about different kinds of treatments?
• Did you feel the doctor spent enough time with you?

Trust yourself when deciding whether this doctor is right for you. Keep in mind, though, that relationships take time to develop and you may need more than a single visit before you and your doctor really get to know each other.

Some of the questions about the doctor you may want answered include:

Is the doctor board certified?

Doctors who are board certified have had extra training in special treatment areas, such as medical oncology (cancer care), hematology (diseases of the blood), or gynecologic surgery (female reproductive system). They have taken and passed certification tests given by doctors in their field. To keep their certification, doctors must continue their education and keep up with advances and changes in their specialty area.

Not all doctors who are specialists are board certified. Doctors do not need to be board certified to be excellent caregivers. Still, many doctors become board certified in at least 1 specialty.

To find out if a doctor is board certified, contact the American Board of Medical Specialties (ABMS) at www.abms.org. The ABMS has a list of board certified doctors who subscribe to the ABMS service. You can do a free search for all doctors in a certain specialty by state. Or you can type in the name of the doctor you have questions about to learn about their specialty. You can also learn more about what board certification means at the ABSM Web site.

Information on doctors who have extra training and certification may also be available at your public library. Ask for the Official ABMS Directory of Board Certified Medical Specialists, or get your librarian to help you.

What is the doctor's experience?

Find out how long the doctor has been in practice. Ask how many people with cancer he or she has treated. If you are thinking about surgery or special procedure, you may want to ask about the number of these procedures the doctor has performed. How many patients is the doctor currently treating? How many are cancer patients? How much experience does this doctor have with your type of cancer?

Along with finding out about the doctor's experience, you may also want to find out who the leading specialists in the field are. A visit to a medical library may be useful. You can do research on the Internet, too. You can start with us, or go to other respected Web sites like cancer.gov, healthfinder.gov, or medlineplus.gov. Look for the names of doctors who have written about the cancer you have and whose work is most often quoted. If your doctor has published his research, you may ask to look at those articles online or get copies at the library. By doing so, you can learn more about the doctor's approach to cancer treatment.

With what hospitals is the doctor affiliated?

Where you will get inpatient cancer care is determined by where your doctor practices. Find out where you would go for surgery or other care. Check with your health insurance company, to see which doctors and hospitals your insurance plan covers.

Is the doctor affiliated with any medical schools?

Teaching affiliation (association) with a respected medical school may suggest that a doctor is a leader in his or her field. Doctors who teach and who also practice medicine often are in contact with medical experts from around the country. They may know more about the latest treatments.

Other questions to ask:

• Are you or your practice involved in clinical trials (medical studies) of new treatments?
• What are your office hours?
• How can I reach a doctor after hours?
• Who will see me when you are on vacation?
• Who else will be on my health care team?
• May I bring someone with me to my appointments?

It's helpful to ask around about a doctor's reputation, but in the end, trust your gut. You should feel comfortable not only with your doctor's ability to treat your cancer but also with how he or she treats you as a person. Can you talk with this doctor? Does he or she listen to you? If it doesn't feel right, keep looking.

More ways to find a doctor

The American Medical Association (AMA), on the Web at www.ama-assn.org represents many doctors in the United States and offers a doctor locator service called "Doctor Finder." Through this free service, you can find information about doctors, such as their contact information, medical school, residency training, and specialty area(s).

Another source of information is the American Society of Clinical Oncology (ASCO), on the Web at www.asco.org. This is an international medical society representing cancer specialists involved in clinical research and patient care. They provide an oncologist directory, which is a database of ASCO members called the "Membership Directory." You will have to create a guest account to use this database, but there is no fee to do so.

You might also contact the nearest cancer centers and ask for doctors who are specialists in your type of cancer. Consider asking family, friends, nurses, and other doctors in your community. Most hospitals have a doctor referral service, too. You could also call medical schools or medical societies in your area. Once you have come up with some names, you might start by getting the answers to some of the same questions you asked before, for example, board certification and experience.

Second opinions

Even after you have chosen your doctor, you may want to get a second opinion. This is an especially good idea if you feel uncertain about the proposed treatment. For example, if you have prostate cancer and a urologist has recommended surgery, you may want to see a radiation oncologist to learn about non-surgical treatment. Consider getting a second opinion when:

• You want to be sure you have explored all options.
• You think the doctor underestimates the seriousness of your illness.
• The doctor doesn't know what is wrong with you.
• You have a rare or unusual cancer.
• You think there may be another treatment available.
• Your insurance plan requires it.

Before you begin looking for a second opinion, contact your insurance company to find out what your policy covers. In some cases, you may have to get a second opinion from another doctor who is part of your health plan before the plan will pay for your treatment.

Tell your doctor you plan to get a second opinion. It is common for patients to do this, so most doctors are comfortable with the request. You may want to ask your doctor to recommend someone. You may also want to look at the section, "More ways to find a doctor," for suggestions.

Once you have decided who you will see for your second opinion, ask that your medical records, original x-rays, and test results be shared with the referral doctor. You will need to sign a release of information form. Or you may want to take copies of your medical records to the new doctor yourself. Be sure to take all of your medicines (including vitamins, supplements, and drugs you take only when needed) with you on your first visit. The new doctor will review your medical history, prior test results, do a physical exam, and maybe do other tests, too.

Choosing a good hospital

Most doctors who treat cancer work with hospitals that are good at cancer care. Ask other doctors and nurses for their opinions on hospitals in your area. Cancer experience is also important for hospitals. For example, larger hospitals may have more experience with different kinds of cancers and offer more services for cancer patients. If you live in a small town, you may need to travel to a larger city to find a center with enough cancer experience.

This might be especially important if you have a rare type of cancer or if you have something unusual occur along with your diagnosis. Larger institutions will have more experience in treating less common cancers. This experience advantage may be the key to getting the best possible treatment and be well worth any extra travel or inconvenience to you in the short-term.

You may also go online to find out if nearby hospitals meet certain quality standards and are accredited by The Joint Commission at www.jointcommission.org. Keep in mind, though, that accreditation does not necessarily mean the hospital has expertise in cancer care. Online, The Joint Commission's Quality Check allows you to check on the performance of your local health care facility. From their home page, click the "Find an Organization" button under "Quality Check: Find a Health Care Organization," then search for your health care organization by its name, zip code, or state. If you don't have Internet access, ask your local public library staff if they can help you, or call the Joint Commission help line at 630-792-5800.

Additional resources

More information from your American Cancer Society

We have selected some related information that may also be helpful to you. You can order these materials from our toll-free number, 1-800-227-2345.

After Diagnosis: A Guide for Patients and Families (also available in Spanish)

How to Choose a Hospital:Worksheet

How to Choose a Doctor:Worksheet

Health Professionals Associated With Cancer Care

Talking With Your Doctor (also available in Spanish)

National Cancer Institute Cancer Center Programs

Pediatric Cancer Centers

Health Insurance and Financial Assistance for the Cancer Patient (also available in Spanish)

Talking With Friends and Relatives About Your Cancer (also available in Spanish)

A Message of Hope: Coping With Cancer in Everyday Life (also available in Spanish)

Books

The following books are available from the American Cancer Society. Call us to ask about costs or to place your order.

Cancer in the Family: Helping Children Cope With a Parent's Illness

Couples Confronting Cancer: Keeping Your Relationship Strong

What Helped Get Me Through: Cancer Survivors Share Wisdom and Hope

What to Eat During Cancer Treatment (cookbook)

National organizations and Web sites*

Along with the American Cancer Society, other sources of information and support include:

Finding doctors:

American Board of Medical Specialties (ABMS)
Toll-free number: 1-866-ASK-ABMS (1-866-275-2267)
Web site: www.abms.org

Information about whether a doctor is certified by an ABMS Board is available via the Web site or phone number.

American Medical Association (AMA)
Toll-free number: 1-800-262-3211
Web site: www.ama-assn.org

Get information on specific doctors, or search for doctors by specialty and location, by choosing the "Doctor Finder" tab on the home page. You can find contact information, medical school and residency training, specialties, and major professional activities.

American Society of Clinical Oncology (ASCO)
Web site: www.cancer.net

Offers information that's been approved by oncologists to help make health care decisions. You can also choose "Find an Oncologist" in ASCO's worldwide member oncologist locator.

Treatment center and hospital information:

American College of Surgeons Commission on Cancer
Toll-free number: 1-800-621-4111
Web site: www.facs.org/cancer

Find a CoC-accredited cancer program near you or search for a qualified surgeon. Web site also offers information about diseases, lab tests, preparing for an operation and recovery (information also available in Spanish).

CureSearch National Childhood Cancer Foundation (NCCF)
Toll-free number: 1-800-458-6223
Web site: www.curesearch.org

Up-to-date information about childhood cancer from the world's foremost pediatric cancer experts. Web site also has a list of COG institutions by state.

The Joint Commission
Toll-free number: 1-800-994-6610
Web site: www.jointcommission.org

Offers "Quality Check," a guide to US hospitals. Go right to www.qualitycheck.org, or call 630-792-5800 to get information about the quality and safety of accredited organizations.

National Cancer Institute (NCI)
Toll-free number: 1-800-4-CANCER (1-800-422-6237)
TTY: 1-800-332-8615
Web site: www cancer.gov

To find NCI-designated Cancer Centers; also offers a lot of other good information on many cancer-related topics.

*Inclusion on this list does not imply endorsement by the American Cancer Society.

No matter who you are, we can help. Contact us anytime, day or night, for cancer-related information and support. Call us at 1-800-227-2345 or visit cancer.org.

References

American Board of Medical Specialties. About Board Certification. Accessed at www.abms.org./About_Board_Certification/ on June 22, 2010.

American College of Surgeons. Commission on Cancer. Accessed at www.facs.org/cancer/ on June 21, 2010.

American Medical Association. Doctor Finder. Accessed at www.ama-assn.org/ on June 23, 2010.

American Society of Clinical Oncology. Find an Oncologist. Accessed at www.cancer.net/patient/Publications+and+Resources/Find+an+Oncologist on June 22, 2010.

Eyre HJ, Lange DP, Morris LB. Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment, and Recovery. 2nd Ed. Atlanta, GA: American Cancer Society. 2002.

Hewitt M, Simone JV (Eds), National Cancer Policy Board, Institute of Medicine, and National Research Council. Ensuring Quality Cancer Care. Washington DC, National Academy Press, 1999. Accessed at www.nap.edu/catalog.php?record_id=6467 on June 22, 2010.

National Cancer Institute. Cancer Centers List. Accessed at http://cancercenters.cancer.gov/cancer_centers/cancer-centers-names.html on June 23, 2010.

Ross JA, Olshan AF. Pediatric Cancer in the United States: The Children's Oncology Group Epidemiology Research Program. Cancer Epidemiol Biomarkers Prev. 2004;13:1552-1554.

The Joint Commission. About Quality Check. Accessed at www.jointcommission.org/QualityCheck/06_about_qc.htm on June 22, 2010.

The Joint Commission. Quality Check™. Accessed at www.qualitycheck.org/consumer/searchQCR.aspx on June 23, 2010.