12/01/2011 - Articles

Preparing for Doctor Visits and Knowing Your Prostate Cancer Surgeon

By: John Russo, Jr., PharmD


Prostate Cancer? Know Your Surgeon

My friend was diagnosed with prostate cancer last week. As I discovered a decade ago, such an event challenges you to confront your eventual mortality at the same time you’re being pressed to make life and death treatment decisions. For some, the combination is overwhelming. So, they delegate these decisions to the doctor. There is another option — you can take charge, head on.

The latter path involves taking your power to learn about treatments and then recruiting a team to advise and implement the best options. It’s analogous to being the coach of a football team. The quarterback (surgeon) executes the plays, but you select the quarterback and have input on your way to a successful outcome.

What qualifies a surgeon to perform your radical prostatectomy?
Don’t be distracted by institutional reputations, the latest gizmos, or where your neighbor had his operation. When it comes to prostate cancer and the surgical procedure known as a radical prostatectomy, an experienced surgeon is the prime requisite.

Outcomes improve as a surgeon's experience increases. In fact, the "magic number" to minimize the risk of prostate cancer recurrence (i.e., prostate-specific antigen [PSA] greater than 0.4 ng/mL) is 250. That’s right, the learning curve for becoming an expert in this complicated surgical procedure is steep and doesn’t plateau until the surgeon completes approximately 250 operations.

How experienced is your surgeon?
A surgeon performing a radical prostatectomy twice each week doesn’t plateau for almost two-and-a-half years. On the other hand, surgeons performing 10 procedures each week offer the best chance of success after about six months. The more active surgeon is also better positioned to incorporate and optimize modifications and advances in the surgical procedure.

When surgery is the treatment of choice, satisfy yourself that your surgeon has the sufficient experience to ensure the best outcome. At the same time, prepare yourself to benefit from each doctor visit. More about this is discussed in the next article.

Preparing to Spend Quality Time With Your Doctor
John Russo, Jr., PharmD

My parents never questioned our family doctor. In fact, they barely spoke to him. It was the 1950s. In the examination room they had about a minute to explain their problem to the busy doctor. Then, he left the room for a while. He never explained why; it was just part of the routine.

When he returned, prescription in hand, the directions were brief and to the point. "Get this filled. Take it as I've directed. Come back in two weeks."

Fortunately, doctors today are less aloof, and they are not put off when patients take an active interest in their healthcare. Here’s a game plan to make the most of each doctor visit.

The night before leaving for the doctor’s office

  • Write down your symptoms and major complaints
  • Write down questions you want answered — most important questions first
  • Prepare your "health history" (previous illnesses, hospitalizations, allergies, test results)
  • Ask a relative or trusted friend to accompany you in order to later confirm your doctor’s instructions

Items you must bring with you

  • Put your medicines in a bag, or list the drug names, dosages, how often and when you take them
  • Include supplements and over-the-counter medicines
  • Bring a notebook and pencil to record what you’re told by the doctor
  • Don’t forget your health insurance card and referral

At the office

  • Arrive early to complete any forms
  • Ask for help if you don’t understand the questions
  • Prepare to present your insurance card or referral to the clerk

The doctor visit

  • Give the doctor everything you brought: medicines, lists of symptoms and complaints
  • Take notes on what the doctor says, or have your companion do it
  • Learn how to take new prescription drugs, for how long, and their side effects
  • Prescription drugs are expensive; ask if a generic drug might be taken instead
  • Be sure all questions are answered, even if they seem unimportant

Before you leave the office

  • Make a follow-up appointment, if necessary
  • For referrals, be sure to understand what you must do and what the office clerk will do to set up that appointment

Home again

  • Review your notes, and call the doctor if you have more questions
  • Fill prescriptions
  • Start taking your medicine and record any side effects

It’s a lot to do, but it’s your health that’s at stake.

Created on: 11/30/2011
Reviewed on: 12/01/2011

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