Being an oncologist is no easy gig.
After about a dozen years of higher learning, internships, fellowships, and residency, a newly minted oncologist faces a practice-load of patients, and must keep up with the high demands of a fast-evolving field.
While job satisfaction tends to be high, so are rates of depression. The challenges most oncologists face in order to deliver the best possible patient care are not insignificant and can negatively impact patient care.
Living with cancer is also no easy gig.
This is your one life. You are dealing with your own set of real-time stressors. Your oncologist can make the difference between life and death, and otherwise impact quality of life on your cancer journey.
Sometimes it’s necessary to part ways with your oncologist. There are times when circumstances demand finding a better fit for your unique situation and priorities.
Yes, breaking up can be hard to do but, given the enormous stakes, don’t accept anything less than stellar, supportive care.
Following are 13 situations that may trigger a breakup.
13 Reasons to Break Up With Your Oncologist
Your personalities just don’t gel
If you get pushback at almost every turn, and your oncologist is often dismissive of the sensible concerns you raise, and if the chemistry and vibe just doesn’t feel right, then the ‘relationship’ is a nonstarter.
Not a good listener
Physicians who don’t take the time to listen to each patient’s unique story, along with their concerns and health goals, are not effectively serving those clients.
While it is necessary to recognize the allotted time for appointments, new patient appointments should allow plenty of time to meaningfully engage. You should not feel rushed in a critical first connection with your new oncologist.
If you have topics to raise during a follow-up appointment, then make sure to schedule accordingly with your oncologist’s admin—this is respectful to your oncologist and the patients in the waiting room.
If you are not being ‘heard’, or not getting substantive feedback to your practical inquiries, it’s best to move on.
Frowns on your request to seek a second opinion
Cancer diagnoses are not always accurate; recommended treatment approaches can vary widely. As a cancer coach, it’s not unusual for me to recommend a client seek a second, or third, opinion. With the exception of the most indolent, early diagnosed, early-stage, straight forward cancer diagnoses and prognoses, additional expertise is paramount.
Your oncologist should be comfortable and familiar with the necessity for a second and third opinion, and advocate that you solicit them.
If your oncologist is neither fully comfortable nor supportive of another expert’s assessment, consider leaving your insecure provider.
Rushes you during appointments
If your oncologist often has one hand on the doorknob, take it as an obvious, negative signal. Your oncologist must be present in every sense, and spend the necessary time to get to know you, and address all questions and concerns in an unhurried manner.
Additionally, if more time is spent looking at a screen and typing, and not looking directly into your eyes to meaningfully engage, you’ve got the wrong doc.
Unwilling to share detailed reasons for treatment recommendations
Practically all recommended cancer treatment regimens come from a book, literally—the NCCN Guidelines. This brings consistency to standard oncology care. Oncologists refer to these guidelines and tend to follow them closely.
But there are often several therapeutic options across a multitude of cancer types and at different stages of disease. Your oncologist should be responsive to your question of why a specific approach is being prescribed.
You might even ask your oncologist to print out actual study results related to the recommended treatment plan—the published literature—so you can take it home and read it rather than making a decision on the spot.
Bottom line: If you get pushback for being inquisitive, extricate yourself from that office.
Dismisses your inquiry regarding clinical trial options and other possibilities such as expanded access to novel therapeutics
In addition to the standard of care treatment options informed by the NCCN Guidelines, there are a number of cancer clinical trials available across many types of disease, and there could be viable options for you to consider. Expanded access allows individuals to: access drugs that are being used in trials/experimental settings get special authorization by the FDA and the drug manufacturer, secure medications, and at no cost for the drug itself.
If your oncologist is not willing to invest the time to take lead to identify options that may be a good fit, then you are in the wrong practice.
Note: cancer care is a business—a thriving industry; most clinics prefer not to lose patients to a trial, especially if they are not the ones running it.
To be fair, it can be difficult for small community oncology clinics—with one or a few oncologists—to invest the required (and unbillable/non-reimbursable) time and resources to do this level of research and outreach. An academic center is often better resourced to expeditiously and comprehensively explore these options.
[Related content: Beyond Standard Cancer Care: Intelligent Considerations]
Unwilling to discuss your legitimate findings in the literature or lay press
Smart patients are doing their own research using Google Scholar and PubMed to review the peer reviewed and published literature on the specific disease they are hosting. They are also seeking the most reliable information from other reputable sources online. Your oncologist should embrace the fact that you are involved, at this level, in your own care for your one precious life, and should take the time to discuss what you have found.
Conversely, don’t expect much time and attention if you bring your oncologist printouts of articles and findings from low-quality sources that either (a) fall beyond their purview of experience and education, or (b) point to yet another alternative cancer cure testimonial, devoid of scientific rigor.
Within reason, given your respect for time and the quality of your information sources, if your oncologist frowns upon your proactivity, head for the door.
Lack of empathy for emotional impacts
The psychological and emotional aspects of hosting cancer can be every bit as ‘heavy’ as the physical ones. In my coaching practice I have seen many situations where the emotional burden far outweighs and overwhelms the prognosis itself. This can even be the case with early-stage, more indolent disease that is largely curable, and those placed into a category of active surveillance or watchful waiting (what I have redefined and coined ‘proactive observation’) for malignancies such as chronic lymphocytic leukemia and prostate cancer.
- Does your oncologist ask how you are doing emotionally?
- Would you be comfortable openly sharing how you are feeling emotionally?
- Have you shared before, only to get an “I’m sorry, it will get better” type of response?
- Has an offer of a prescription for, say, anxiety and/or depression been made without an accompanied referral to a social worker, therapist, or psychologist (ideally an onco-psychology or psychosocial oncology specialist)?
If you’re not getting compassionate, empathetic support, this is a sign that your oncologist is not ‘feeling you’. And it is reason to find one who is.
Lack of empathy for physical impacts
If you are struggling with the deleterious side effects from treatment, recovery, or from the underlying malignancy itself, and every effort has not been made on the part of your oncologist to manage these challenges as expeditiously and comprehensively as possible—using all the tools and professional referrals at their disposal—then you have brought your ‘business’ to the wrong practice.
Lack of responsiveness
An unresponsive oncologist or oncology clinic manager or administrator is not acceptable, including when your primary care physician or other providers are coordinating different aspects of the management of your care. The same goes for their interactions with your family member(s) or other caregiver(s) that you authorized to advocate and otherwise engage on your behalf.
- More than 24 hours to return calls after leaving multiple messages?
- Return calls from triage nurses or physician assistant, but not getting to the root of your concerns?
- Is the practice pushing for a clinical appointment for you to be seen when it may not be necessary to solve the immediate issue?
These are red flags.
You deserve no less than to be partnered with a practice that responds quickly and decisively, with quality engagement and solutions for you and your entire care team.
Is not well-prepared
Do you feel like you start over, restating your ‘story’ at the start of the first few visits? If your oncologist often walks into the clinic room ‘cold’, seemingly without having read over your chart, albeit briefly, to catch up with where you are at in the here and now—ex.: treatment course and any issues or concerns recorded since your last clinic visit – that is far from the ideal oncology partner, and is an omen of the lack of attention that could compromise your care at some point along the journey.
If your oncologist seems to be winging it, on auto-pilot, or being more reactive than proactive in the management of your care, then it’s time to bail.
Outright dismissal of your efforts around lifestyle- change and core tenets of integrative oncology.
The evidence is irrefutable in terms of the power of nutrition and physical activity to help prevent a majority of malignant disease. The American Cancer Society and NIH’s National Cancer Institute prominently message this on their respective websites.
In terms of the impact of lifestyle changes such as diet, exercise, stress reduction, clean hydration, supplementation, and social connectedness—during active cancer treatment, treatment recovery, and to help ensure deep and durable remission—you don’t need your oncologist’s tacit approval to do these things.
These activities all point toward strengthening immune function, increasing resiliency, and expanding one’s emotional fortitude. If, from a physical standpoint, you are otherwise cleared to focus on these areas, go for it.
In this day and age, any oncologist should support the physical and emotional fitness of their patients. If your oncologist is less than wholly supportive, or otherwise dismissive, of your interest in becoming the ‘healthiest possible’—who happens to be hosting an underlying disease—they should be fired post haste.
Talk like “live however you choose, but it will have no impact on the course of disease” is grounds for immediate dismissal.
Outright objection to supplementation.
If your oncologist advises against taking natural products and supplementation, before, during, and after treatment, then take some time to think about their openness and where they fit in this specific area of the management of your care.
Studies have shown that a large percentage of folks living with cancer do not tell their oncologists what supplements they take. It is largely because folks want to avoid pushback, blank stares, or outright dismissal, on anything they share regarding supplementation.
It is important to share a list of all supplementation—vitamins, minerals, botanicals, and mushrooms—because there are contraindications with several anticancer and supportive care drugs.
Your oncologist will be fine supporting select supplementation to address any known vitamin or mineral deficiencies. However, unless they are trained in integrative medicine, integrative oncology, or functional medicine, keep your expectations in check in terms of getting any meaningful feedback on the plethora of products you may be introducing.
[Resource: Directory of Integrative Oncology Providers]
Conventional oncologists without integrative or functional medicine training and experience almost always suggest that taking supplementation will have no benefit, and can also potentially compromise the efficacy of certain anticancer treatments. As previously noted, the latter can be true, as there are known contraindications that must be avoided.
You don’t need your oncologist to be an expert on supplementation, but you should at least share an updated list of what you are taking, and ideally inform your doc that you are working with other professionals with expertise in this area for ongoing guidance. It’s important for both doctor and patient to be open, honest, and respectful of and with each other. If your oncologist orders you not to use ‘any’ safe supplementation, then you may conclude…
…It’s Not Me, It’s You, Doc
We all must have realistic expectations for our oncologists. A Norman Rockwell bedside manner is somewhat rare. So is the idea that your oncologist will be well-versed in all things lifestyle, supplements, and complementary therapies such as yoga, massage, acupuncture, and meditation.
The aforementioned 13 reasons to break up with your oncologist, to me, are fundamental. They represent the baseline of acceptable behavior or, in this case, the tipping point for dismissal.
It happens. Make the move. Don’t be scared. Make sure you have a replacement chosen, and an appointment already scheduled, before you provide ‘formal notification of break-up’ along with a request to have your medical records transferred.
Join my private Facebook Group Anticancer Thrivers—a community forum for achieving your best life while living with cancer.
Photo credit: bigstockphoto.com/Grisha_Bruev