Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [61]
Like Julie Brody, who used her Rolodex of contacts to find the “best doctor,” Paul Peterson created his list of the “best” experts in CLL. He drew on the rosters of faculty at major cancer centers, then culled the list based on their authorship of articles in prominent medical journals. Paul identified three major cancer centers with experts in his type of leukemia who had published a substantial number of articles in recognized medical journals. Some of the best articles, he concluded, came from a major cancer center in the South. “What I really liked was that they compared the treatment protocols and outcomes of a number of different studies, taking a comprehensive approach, critically analyzing the pros and cons of the various therapeutic strategies.”
Paul Peterson is in that minority of patients, based on the 2007 survey, who selected a specialist based on information from the Internet. As it happened, his hematologist in Connecticut knew the expert in CLL at that cancer center. “This personal connection between them kind of added to my decision to get a second opinion there,” Paul said. As with Julie Brody, the personal endorsement from another doctor carried weight.
The next week, he traveled south to the cancer center. “It’s this huge complex,” he said. “You see cranes everywhere, and they must have a hundred thousand employees in the facility. I had this gut reaction that it felt like a center of knowledge and expertise.” But in his work as a strategic consultant implementing rational decision analysis, Paul had long ago learned to be wary of “gut reactions.” He continued, “I was impressed with the management, the way the schedule was already prepared for me. My three days were all set out by time, each appointment and test moving into the next. There was just this incredible efficiency, a sense that everything was well organized, ran smoothly. I said to myself, Okay, these people seem to know how to run patients through here. On the other hand,” Paul told us, “it was very large, and that turned me off a bit. There were literally thousands of cancer patients moving through the center at any one time. Also you are walking through the corridors, seeing these people who are incredibly sick, and it’s not exactly an up experience.”
Paul went to wait in the phlebotomy suite for his blood to be drawn.
“Hey, darling—you, over there,” a plump, older woman in a white coat called out with a deep southern drawl. “Yes, you, Red. Come right here, darling, and sit down with me, and we’ll get this blood test done.”
Paul told us, “It’s just a simple experience like that—this woman was so nice to me, made me feel like an individual.” This mirrored what Julie Brody observed about her oncologist’s office and contributed to what she called “the best experience.” Paul elaborated, “It wasn’t just, Put your arm down, bam, bam, bam, draw your blood, and out you go. Little things like that made me feel that there was something special about the organization. Not that I was convinced everyone in the hospital would be like that. But it was a nice appetizer to go with the main dish, the hospital.”
The next day, Paul saw the doctor. This was the specialist in CLL who had published numerous reports of her own clinical trials and a critique of the field. She was middle-aged, dressed in a starched white coat, with a tall stack of papers on her desk. “I liked her style,” Paul told us. “All business.”
“I have all of your laboratory studies in front of me,” the doctor said. “Let me cut to the chase—it doesn’t look good.”
Paul was taken aback. “What does that mean, precisely?”
The doctor explained