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How to find the "best" doctor?
August 25, 2014 6:13 PM   Subscribe

Let's say you wanted to find the very best ovarian cancer specialist in the US. How would you go about doing that?

Assume that money, travel issues, health insurance, etc. are not an issue. You just want to see the very best doc. How do you find him/her?

I am asking specifically with regards to ovarian cancer, which is frequently diagnosed late and which has dismal survival statistics. (And yes, this is about my bestie. See my question history if interested.) So, "best" would probably mean the person who is the most tuned-in to advances in treatment, since the current and historical treatment end up with almost all patients dead in a relatively short period.

Help.
posted by BlahLaLa to Health & Fitness (20 answers total) 6 users marked this as a favorite
 
You find who's attached to hospitals where Ovarian Cancer is best researched and treated.

John's Hopkins has a special center for Ovarian Cancer.

Sloan Kettering

MD Anderson

Ovarian Cancer runs in my family. I had a prophylactic hysterectomy when I was 41. I think about this subject a lot.

Blessings of health and wellness to your BFF.
posted by Ruthless Bunny at 6:19 PM on August 25 [1 favorite]


Ruthless's answer makes me realize I need to put a few more details in my question. How does one know, for example, that John's Hopkins, Sloan Kettering or MD Anderson are better than, say, UCLA or...or...which among those three is the best? And if you chose a facility, how would you select a physician at that facility? How would you know, or what would the clues be, to show that you are selecting the "best" practitioner?
posted by BlahLaLa at 6:23 PM on August 25


"Best" is subjective. Some doctors work better with some patients than others. Some doctors specialize in different cancer types. But a good doc will ID what's going on and say, "Hey, this is XYZ type ovarian cancer, you want Dr. Silva for that. She's been working on it forever."

My oncologist isn't affiliated with any of those places, but I LOVE her, she's awesome. It helps that she's on my insurance and less than a mile from my house.

If one of my family members were to get Ovarian Cancer, I'd want them to be in a place that posed the least stress as possible (so not having to schlep across country and make arrangements for living and expending money, etc.)

Another option is to see who is working in studies of new therapies, and see if you can get in on that. My bestie was just cured of Hep C in just such a study.

"Best" is hard, because my doc could know everything there is to know about something, but if he's an asshole, it's going to negatively affect my treatment.

Let's just say there's a class of "best" and as long as you're in the neighborhood, you're doing it right.
posted by Ruthless Bunny at 6:31 PM on August 25 [6 favorites]


One tactic would be to just ask the experts in your immediate circle, and then work your way up. So, you ask a doctor within your sphere (ideally, the person who is treating your friend, but it could even be your GP) - "Where in the country is the best treatment for this disease available?" And he gives you an answer, and it might be way off, but you look up the hospital, find out who is on staff, and figure out if you can network/pester/charm anyone there to answer your questions by email - or even have coffee - and they give you a more specific answer, and you repeat that process until you have an answer you're satisfied with.

Alternatively, you could pay for access to Pubmed or any of the other depositories of medical research journals and search for the most cited articles on ovarian cancer - if one set of names, or one university, shows up repeatedly, that would be a good clue.

Finally, you could just google variations of the relevant keywords (ovarian cancer, treatment, research, best) until you find some relevant journalism, and then decide for yourself, using your common sense and life experience, what sources are reliable. I did this for about five minutes and I'm fairly confident that Ruthless Bunny is right that the most prestigious centers are Sloan Kettering and Johns Hopkins, and with a little more research, I'm sure we could find the doctors with the best reputations at those hospitals. She is also right to note, though, that "best" has a lot of different variations in meaning, and you should work with your friend to figure out what doctor is right for her.

I wish you the best of luck in this difficult time.
posted by pretentious illiterate at 6:39 PM on August 25


IMO, the best way to find the best specialist is to ask another specialist (or two or three). We found "the best" specialist for a specific kind of sinus cancer by asking a local doctor who was also a specialist in sinus cancer. We decided that a 3-hour drive was worth it in this particular case, but the math might have been different if we faced multiple cross-country trips, and we might have sacrificed "the best" for a very, very good local doctor.

US News and World Report ranks hospitals along a variety of metrics: Cancer and Gynecology among them.

Another way is to ask other ovarian cancer survivors which doctor they would recommend. This is a very common question in various online cancer communities, especially narrowed down by hospital.
posted by muddgirl at 6:39 PM on August 25


I remember your question. I was the snarky mom who got excellent treatment at the Dana Farber/Mass General Cancer Center. I'm cancer free now.

This WebMD article talks about how to find the best cancer doctor:

"When it comes to cancer, not all doctors and hospitals are created equal. At minimum, says J. Leonard Lichtenfeld, MD, deputy chief medical officer with the American Cancer Society, you should find a doctor affiliated with a hospital that is accredited by the Commission on Cancer. "These programs have multidisciplinary teams, information about access to clinical trials, and comprehensive, state-of-the-art care," Lichtenfeld says.

If there is a comprehensive cancer center, designated by the National Cancer Institute, near you, it's a good idea to seek care or at least an opinion from one of these top-notch centers."
posted by kinetic at 6:40 PM on August 25 [3 favorites]


The reason that the facility itself is so important, above and beyond the individual doctor (or really a team of "the best" doctors, since cancer treatment is multi-faceted nowadays), is really the community of care - from the doctors to the PAs, nurses, nurse's aides, patient care coordinators and even volunteers. You'll really only see "the best" doctor for a few hours of face time total (plus surgery if that occurs, but she'll be asleep for that), so it's important to also look at what the rest of the patient experience is like.
posted by muddgirl at 7:30 PM on August 25 [3 favorites]


There is no way that any physician you ask would know who is “the best” at combining knowledge of the latest medicine, personal intuitiveness, and an outstanding bedside manner. But you could come close.

Looking at who has authored several articles on the topic would tell you who knows the medicine, but very often these academic types will pass off the patient contacts and the day to day care to their residents and fellows. You will no doubt receive excellent care, but it will not be based on the personal attention of the Dr. Hero you may be seeking.
posted by yclipse at 7:58 PM on August 25


I agree with the others above that best can mean a lot of things. However, as someone that has been around a few people who were extremely wealthy, well connected and also had health issues, the big names are Mayo Clinic, John Hopkins, Sloan Kettering, and Cleveland Clinic.
posted by ill3 at 8:28 PM on August 25


My good friend's sister went to Johns Hopkins under similar circumstances. The reason she did, and the person they picked to consult, was based on recommendations from her local doctors as they realized her case was a difficult one and thought about where she might go for better help. I think location did factor into it a bit, though they actually probably live a bit closer to Sloan Kettering than Johns Hopkins. I think it went like this: logistics ruled out places too far from the Mid-Atlantic region (mainly because of $ and because she has young kids), and so they narrowed it to SK vs. JH, and went with JH based on recommendations.

As kinetic quotes, when you need to go to the experts, you are looking for: These programs have multidisciplinary teams, information about access to clinical trials, and comprehensive, state-of-the-art care"

What Ruthless Bunny says is also true: Let's just say there's a class of "best" and as long as you're in the neighborhood, you're doing it right.
posted by gudrun at 8:33 PM on August 25


I used to do this when I worked in finance evaluating biotech stocks, and had to identify the thought leaders for expert consultations.

Now thought leaders are not necessarily the "best" doctor in the sense that being a good doctor includes empathy and other stuff like that, but they're the most up to date on research in the field.

What I'd do to find them:

Head to Pubmed, which indexes medical research articles in a number of journals. Search for "ovarian cancer". Pay attention to the journal. The New England Journal of Medicine and Lancet are both very highly regarded. Avoid journals discussing more the science of the mechanism (e.g. Applied Biochemistry or something like that).

For example, this is a good search. Actual articles are better than comments, though both are valuable. E.g., this looks like a good article. The first and last authors are the ones you want to pay attention to the most. For example, the first author of that article looks like a strong candidate. Academic doctors often have contact information in the journal article itself or on their school/hospital website.

Next, head to ClinicalTrials.gov, the official repository of ongoing clinical trials in the U.S. Use the advanced search to find trials for "ovarian cancer" that are in Phase 3 (large, late-stage trials). For example, this trial looks good. Take a look at the Principal Investigators (the doctors in charge of the trial). One of them, Dr. Ursula Matulonis, is in the U.S. at the DFCI. Searching their site, you can find her profile page with contact information.

After a few searches of papers and trials, you can compile a list of, say, 10 publishing, cutting edge academic doctors. Then you can email them, and ask for a recommendation for "top ovarian cancer specialist near XYZ" or something like that, and see if they recommend anyone. You'll likely get a couple responses out of 10 emails, and they might agree on someone.
posted by losvedir at 8:36 PM on August 25 [2 favorites]


Cancer is a team sport these days, so once you find the good programs, you should probably talk with out a few different doctors in each and figure out which one you feel best about so as to avoid the jerk doctor problem.

On the topic of where to go: When I was asking around about another type of cancer, the advice I got from people who knew I was in Seattle was. The Hutch (Fred Hutchinson Cancer Research Center) is good, but if you/they are willing to travel, M.D. Anderson. The patient happened to be in TX. The care he received was exceptional.

Everyone seemed to understand the problem they were trying to solve, and how they could best help. How they could help wasn't confined to their narrow role. It included things like a specialist technician rescheduling a number of appointments of all sorts when she found out that the patient was driving in 4-5 hours at the beginning of the week for treatment, and then back at the end of the week. She did it of her own volition so that the patient could spend another day at home every week. What's exceptional is that, apparently, that wasn't exceptional. She knew exactly what to do, had the access needed to the software to take care of it in a short amount of time. There were other things too, the way they had an in house dental clinic so patients getting treatments that could exacerbate latent dental problems could get their teeth attended to before treatment, and without having to go somewhere else.

I don't know if MD Anderson is a top facility for Ovarian cancer, but its good to have a sense of what excellent cancer care is like.
posted by Good Brain at 9:04 PM on August 25


Not to be discouraging, when I had a similar question for prostate cancer, I came to the conclusion that doctors become known through publicity, not through clinical success. The best surgeon could be practicing in some community hospital somewhere, and be completely unknown.

That said, a cancer patient probably gets the best treatment at one of the major medical centers like the ones mentioned. The level of TLC might be better closer to home.

For treatments like chemo, you may be able to have the treatment guided by the big cheese, but actually provided locally. The docs I've dealt with are very open to 2nd opinions and consultation with the acknowledged experts.
posted by SemiSalt at 5:28 AM on August 26 [1 favorite]


There are probably a few pioneers out there in diagnostics who might be better at identifying certain cancers earlier than other doctors. And there are always new clinical trials being initiated, the results of which nobody can predict in advance. But beyond that, for patients who have already been diagnosed and are looking for the best possible treatment, there should not be a great deal of difference in the level of treatment provided by different specialists for a given disease.

All specialists will be up-to-date with the field. It is actually a mandatory part of their profession to keep abreast of new developments in therapy. Modern medicine is not full of cowboys all doing different things with highly variable outcomes depending on the doctor. Treatment protocols are established by teams of specialists after careful assessment of the literature. These teams then draft, amend and review the treatment guidelines that are followed by the rest of the medical community. This (warning:pdf) is what the Australian official clinical practice guidelines looks like for the management of women with epithelial ovarian cancer, I'm sure there is a US-equivalent. I suppose the "best-of-the-best" would be those doctors that comprise these advisory panels, in this case for ovarian cancer. They would almost certainly be a collection of senior specialists from the larger cancer centers and/or individuals who research and publish regularly in the field.

But even if you had such an individual as your personal physician, I don't think that the level of treatment would differ from his/her colleague in any measurable way. They would still follow the official guidelines like every other doctor. And your chances of a "dud" doctor are equally slim. Hospitals as a matter of course cross-check patient outcomes according to administering physicians to ensure that all doctors are providing appropriate care.

The only potential game changer is in a clinical trial, and different treatment strategies will be trialled at different centers. However, what constitutes the most promising new strategy will depend entirely upon who you ask, because at the end of the day, nobody knows how a trial is going to turn out.
posted by kisch mokusch at 6:20 AM on August 26 [3 favorites]


I know it's hard to think about this stuff so soon after diagnosis, but I think it's important for your friend to think about what she would want in terms of her treatment. Like, if it came down to painful experimental treatment with an unknown probability of putting her into remission that would require her to spend several weeks in a hospital away from her home town and make it impossible for her to talk, or a less aggressive (though still shitty) treatment that would let her spend relatively good-quality time with her family and friends but probably wouldn't save her life, which would she want to go with? For some people it's obvious: they will take any chance to save their lives. But that's not what everyone wants (it's not, for instance, what most health professionals want; you might try asking specialists both "who's the best" and "who would you go to if you had this condition?").

The best doctor for someone who is willing to take any chance to save their life could well be different from the best doctor for someone who wants to maximize their chances of having a few quality years (or even months).
posted by mskyle at 6:29 AM on August 26


Thank you for the answers so far. They are very helpful.

Just for clarity, if it matters: This is for a patient who is already approx. 1.5 years into treatment, and is looking to stay alive. So yes, potentially painful treatments. Traveling far from home. Spending money. All of it -- to stay alive.
posted by BlahLaLa at 7:46 AM on August 26


If she's already undergoing or just finished treatment, then the first step really should be talking to her current doctors. They should not get offended at the idea that she wants to get second opinions as to her options, or participate in clinical trials, and if she is being treated at a comprehensive cancer center then they should be equipped to find the best-chance trials for her based on her status.

If she's NOT being treated at a comprehensive regional cancer center, I think consulting with the closest one should be the next step.
posted by muddgirl at 9:09 AM on August 26


losvedir's recs are very good. In addition If you know someone who works for a big insurance company, they might have access to quality of care and treatment statistics that are not generally available. This is a bit of a long shot though.

On the note about what "best" might mean: When a relative was diagnosed with prostate cancer, they used three parameters to find the best care for them.
1) find a place that deals with this type of cancer frequently, and that ideally performs lots of the treatment you want. A place with high volume often leads to better specialization of surgeons
2) find a place that has doctors there, or associated with it, who are doing research on the latest treatments (and it may be that someone five years out of med school often has a better sense of the latest treatments compared to someone who is 30 years out)
3) find a place that treats you like a person. Because you have enough crap to deal with.
posted by troytroy at 3:39 PM on August 26


I would agree with these points made above:
- The institution is as important if not more important than the individual physician
- Doctors who do the cutting edge research do not necessarily excel clinically (nor do they necessarily excel in bedside manner)
- The ClinicalTrials.gov recommendation is a really good one, but I would get further information from a physician to determine which of the ongoing trials is the most promising prior to actually trying to enroll in a trial.

My personal approach in order to ensure I or my loved one was getting the best care would be to go to one of the largest and most highly respected academic medical centers - generally, everyone at these locations is up to date with the latest in treatment for any given condition, regardless of whether they are doing research on it or not.

Once I had decided which institution I preferred I would go to the departmental website and look at the profile for each physician in the department. The ones who have a special interest in a specific disease will have that listed in their profile. You will also be able to see all their latest publications to see whether they are doing research in the area and what sort of research it is, if it is applicable to your case (i.e. are they studying people who have failed initial treatment for stage X ovarian cancer, depending on the stage your friend is at? They don't have to be studying exactly that but it would be interesting if they were studying something similar).

Based on personal experience at the Mayo Clinic, I would go there or send my loved one there in a heartbeat. They have a way of coordinating care across specialties and of accommodating people who are traveling from out of town to get care that I find it hard to imagine is replicated anywhere else.
posted by treehorn+bunny at 7:26 PM on August 26


We found an excellent neurosurgeon by asking a lawyer friend to research medical malpractice activity against doctors in our state. In our case, we found a great doc by focusing on someone with a totally "clean" record. Perhaps a similar approach could work for cancer surgeons.

I'm not exactly sure what special sources our friend had access to as a lawyer, but Nolo has a useful guide to doing your own research:
http://www.nolo.com/legal-encyclopedia/how-find-complaints-against-doctor-hospital.html
posted by woodman at 7:37 PM on August 27


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