What is proper etiquette for the newly diagnosed cancer patient/doctor relationship?

I received a phone call yesterday from a young man that was newly diagnosed with prostate cancer from the southeast.
He was interested in robotic surgery and had several questions.
He told me he found a local urologist who performs robotic surgery and asked me what kind of questions he could ask. He was turned off by his primary urologist who he felt, was not interested in speaking about robotics.
Among the questions he asked me was “Can I ask the robotic surgeon how many of these operations he has done?”
That got me to thinking about what are proper questions to ask and what are proper things a physician should do?
The specifics of my thoughts will be for prostate cancer, but the generalities can be diagnosed for many cancer, surgical, and other medial problems.
I personally perform about 6-10 consultations per week for newly diagnosed urologic cancer (mostly prostate, but also bladder and kidney, and less often adrenal and testis.)
What I usually tell patients is that they should feel free to ask anything. They can also interrupt me if they need to without worry while I am speaking.
I think the number of a certain procedure that someone performs is fair. I think how old they are is also fair. Board certification, how long they have been in private practice, and any question is OK to ask.
I recommend patients come in with their families and to take notes. Several patients have had recorders, which I personally do not like very much, but do let patients record our consultation if they choose.
I am open to discussing any therapy for their ailment. For example, for my newly diagnosed prostate cancer patients, we discuss watchful waiting, hormonal therapy, surgery (concentrating on open and robotic (touch on laparoscopic non-robotic); radiation (XRT, seeds, combination, and now cyberknife as a local hospital is advertising it); cryosurgery and HIFU (which is currently not approved by the FDA in the US).
I have had one experience I did not appreciate. I was helping my partner with a patient of his who had a few questions for me. The patient stood up and stepped into my personal space (about 6 inches from my face) and asked me a direct question while staring at me. He explained later he wanted to look into my eyes to see if he believed my answer, regarding whether I could perform his complicated surgery. I did answer questions for about 5 minutes after that.
Other than that, I do not recall being bothered by any question, and if I feel it is irrelevant, may choose not to answer a question, but am not insulted by it.
I also do not have a problem referring patients to different institutions or for different therapies than I can not provide. Our group has not performed an open prostatectomy in over 2 years, so if someone wants an open operation, I refer them to a few excellent open surgeons in our area.
My goal is to make the patient and his family feel as comfortable as possible and choose the therapy or surgeon that they feel most comfortable with. That being said I do, as most physicians do, recommend the therapy that I do best: robotic surgery for prostate cancer. I provide a secure email and ask patients to call or email me if they have any followup questions.
I also suggest second opinions as I believe it helps a patient have more than one opinion on their problem. I often give out the name of a radiation oncologist who I trust, but sometimes a medical oncologist if that would be beneficial.
I also give out the names of 2 robotic surgeons that I would go to if someone in my family had prostate cancer if asked.
I give patients the option of speaking to 2 patients of mine that are similar to them in age and preoperative medical condition. This allows them to speak to someone who had what I expect to be a similar experience. Having a 73 year old man speak to a 53 year old man will not help very much, but he should speak to someone who is in his 70s.
I would welcome input from other physicians and patients about their feelings on this topic, as I am sure my views are not the only views.
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6 thoughts on “What is proper etiquette for the newly diagnosed cancer patient/doctor relationship?

  1. Henry Bolte

    I think the article is beneficial, but I would suggest that more questiosn be added, especially about the other options, like cryosurgery and what the side affects might be (ie: with cryosurgery, can you still ejaculate ?)

  2. Richard Chiaramonte

    Dr. Savatta performed robotic surgery on me in January 2007. I am a 69 year old patient who was completely satisfied with the attention Dr. Savatta and his staff gave me. They were always there to answer any and every question I had. I feel that it is extremely important that you can ask your physician any question or questions you have and Dr. Savatta always answered each and every question thoroughly. Most patients are not prepared to be told that they have cancer and it is very important that they can have an open door policy with the physician – this Dr. Savatta does.

  3. Julius Alston

    I think this is a very valid blog and an important subject. In my opinion you already have a great “bedside manner” and I admire you for trying to better the patient/doctor relationship. I am a 53 old patient who asked a lot of questions and Dr. Savatta answered every one of them which increased my comfort level with him and the robotic procedure. The only other question that I would add – and I think it’s a fair one – How many of your surgeries have resulted in less than favorable outcomes or encountered complications? Certainly surgeries can have good and bad results depending on a patient’s age,health, anatomy etc.. Most reasonable people would accept and appreciate an open and honest answer to such a question.

  4. Robert Colwell

    I have inquired about Robotic surgery for my recently diagnosed prostate cancer. My main questions were petaining to quality of life issues. I am a 62 YO male in good health and in good physical shape. I am quite sexually active, so this concern is as important to me as is the incontenence issue. I was told that males over 60 undergoing this robotic surgery have a 50-50 chance of remaining potent after this surgery. Is this stat correct? I know that much depends on the surgeon’s experience, but this being said, are experienced robotic surgeons showing a 1 in 2 chance of a patient retaining potency following this surgery? I thank you in advance. Robert

  5. Domenico Savatta, MD

    Hello Robert,
    I had a blog entry that you probably would like to read:
    http://www.njurology.com/RoboticSurgeryBlog/2006/06/sexual_life_after_prostate_removal.php
    As for men over 60, that is a very diverse age group. If you have normal function, as characterized by a normal SHIM score, and you can have both nerves saved, I would think you would have a much better than 50% chance to maintain sexual function.
    Most surgeons use sexual intercourse with or without help (viagra, cialis, levitra) as having erections.
    I am trying to collect my data now to see when men get erections back with help, and then how many are able to stop using the meds.
    If you have mild ED, 50% would be a decent guesstimate. If you have normal erections, I would guesstimate 85% with a greater than 50% chance of not needing medicines.
    When I first started doing these I used to tell patients lower numbers.
    After about 70 operations, I have seen the short term (erections at 1 month) improve significantly. Over 40% of men that are normal and have both nerves spared are having full erections with meds at that point. I have to look at my data when I have time and update my statistics and have longer term followup. This is somewhat difficult since men are still getting back erections for up to 18 months and only 28 of my 239 dvP patients have been operated on more than 18 months ago.

  6. Scott

    Below is my response to your comments on the appropriate questions for a patient to ask a surgeon whom he is considering for prostate cancer treatment.
    In my case, I consulted with a number of physicians: two who perform open prostatectomies, two who perform robotic, and one who performs combination seed/XRT radiation. In addition, I met with my PCP for his opinions and referrals (he gave me your name). I also researched using the internet, and had my 33 year old daughter who lives in Boston assist me with the research, focusing on the treatment offered in the excellent hospitals in the Boston area. For me two opinions would not have been nearly enough. There are simply too many alternative therapies available for prostate cancer to have only two opinions. All the doctors that I met with encouraged me to get other opinions. I would avoid any doctor who would not encourage me to do so.
    I prepared a list of questions before each consultation. I asked all the doctors that I met with questions about alternative therapies to the one that they specialize in.
    Regarding robotic surgery, I feel strongly that the number of procedures that the surgeon has performed is an essential question. In your case, I also asked you why I should choose you when you had done less than 100 procedures over Dr. Esposito who had done over 500. You gave an excellent answer.
    Although I did not ask it, I think a good question would be to ask the surgeon what is the worst outcome that he or she has had from the surgery? The follow up question would be why do you believe that I will not have a similar bad outcome?
    I also focused my questions so that I could determine whether the surgeon was still learning to perform his or her surgical technique. My goal was to avoid any one who thought they knew all there is to know, or who felt that he or she was the best one available for my treatment.
    Taking family members to meet with the doctors is also essential. In my case, Susan is an Episcopal Priest who has worked as a chaplain, and has had contact with far more physicians than I. Therefore, I valued her opinion of the doctors that I was considering. In addition, I felt it important that I also consult with the doctors on my own, so I could conduct my own line of questioning without interruptions. You may recall that I talked with you on the phone and met with you alone, before I had a second consultation with you along with Susy.
    Based on my research and consultations, I felt that robotic surgery or combination radiation were both excellent alternatives for me. I basically chose robotic because it seemed to have the edge in the long-term non-recurrence of the cancer, and have the largest number of alternative therapies should the cancer recur.
    Fortunately, many of us with prostate cancer have the time to be able to consult with a number of different doctors. I found it extremely helpful to take advantage of this opportunity.
    I hope you have found my response helpful. You have my permission to quote any or all of it as you see fit. Please feel free to ask me any other questions that you have.
    Thank you for you interest in my opinion.

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