Monday, July 30, 2007

Finding The Right Cancer Surgeon

The Sunday July 29 New York Times carries a front-page piece “Cancer Patients, Lost in a Maze of Uneven Care, Sick, Scared, and Daunted by Complicated Choices”

The piece is essentially the story of two patients.

•Karen Pasuqauletto, 35, of Amherst, New York, who had an advanced metastatic colon cancer diagnosed just after giving birth to her first child. She bounced around among various specialists, even going to Seattle for advice at the Seattle Care Alliance and Swedish Cancer Institute. Finally, after multiple bouts of chemotherapy, she was referred to Michael Chotti, a Johns Hopkins surgeon who specializes in removing metastatic colon cancer masses from the liver. Eleven months after her initial diagnosis, Chotti operated for eight hours and removed four masses from her liver and one from her colon.

•Gordon Hendrickson, 66, of Albuquerque, was diagnosed with pancreatic cancer in 2002. The tumor, which was small, required a Whipple procedure. His internist found that M.D, Anderson had extensive experience with the Whipple procedure. MD Anderson required a $5000 deposit. Hendrickson had the operation, and was left with $80,000 in bills, which his health plan, Presbyterian Health Plan, refused to pay. Hendrickson fought his insurance plan and ended up before the state review board, where it was determined that the five surgeons at Presbyterian Hospital had performed only 5 Whipples between them. Ultimately Hendrickson won the case, and Presbyterian paid the bill in full. At his 5 year follow-up at M.D, Anderson, Hendrickson was said to be free of cancer.

The main point of the article is that it is difficult for patients to locate surgeons with sufficient experience in performing complex operations – such as removing metastatic tumor masses from the liver and doing a Whipple procedure.

For the last ten years, I have served on the Advisory Board of America’s Top Doctors, a book produced by the Castle Connolly Medical, Ltd. The 1200+ page book contains names, phone numbers, educational background, date of graduation from medical school, and institutional affiliation of 3000+ specialists, selected on the basis on nominations by specialists, residency directors, and others. In 2005, Castle Connolly published America’s Top Doctors for Cancer, which contains similar information on 2000 top oncologists and cancer surgeons. It is 678 pages long and is indexed by cancer center and names of physicians


Philippa Kennealy, The Entrepreneurial MD Coach said...

I'm happy to report that there is at least one resource available to help patients navigate the overwhelming maze of options. For my weekly podcast (, I recently interviewed Dr Delia Chiaramonte of Insight Medical Consultants ( who does just this work on behalf of patients. She begins with discovery, to better understand their situation, and then delves into researching treatment and physician service options, clarifying choices and providing level-headed emotional support. The final product is a treatment plan formulated jointly with the now-educated patient. The primary treating physician is kept in the loop all along the way.
Her patients are satisfied, and she has innovated in a way that permits her to love the practice of medicine again!

Richard L. Reece, MD said...

Truth be known, I suspect most physicians try to help patients navigate the so-called medical maze. However, many patients have minds of their own. The typical Medicare patient sees six doctors each year. The American College of Physicians and American Association of Family Physicians says each patient should have a single "medical home" with a primary care physicians. This sounds good to me, but I wonder if it is workable.