Evaluate Doctors
Find a neurosurgeon experienced in brain tumor surgery
First priority is diagnosis and treatment as soon as possible. This means surgery, regardless of tumor type. For the vast majority of brain tumors, surgery is the most definitive treatment as no other procedure will remove more tumor cells from your brain.
Surgery should be done with little delay, for two basic reasons. First: It is easier and safer to remove a tumor when it is still small, before it's had more time to grow. Second: You cannot be certain of the kind of tumor you have until a surgical specimen is examined by a neuropathologist. Worst case scenario are tumors that grow at a rate of 10% of their volume per week! Even if you have a tumor like that, the sooner it is removed and you start adjuvant treatment - the better!
There are cases for which the risk of surgery is said to be too high. This assessment depends in large part on the location of the tumor in the brain. But what is considered high risk by one surgeon may be within acceptable levels of risk to another. "Inoperable" therefore, may be a matter of opinion. When you hear the word inoperable, don't hesitate to get another opinion.
Who do you go to for an opinion?
In researching your options, you will ultimately discover a wide variation in the surgical experience, and ability, between neurosurgeons. Consider this: according to Patrick J. Kelly, M.D., F.A.C.S. - Professor and Chairman of Neurosurgery at NYU Medical Center, and Founder and President of The Brain Tumor Foundation - there are 21,000 primary brain tumors diagnosed each year (nearly all have surgery) and about 10% of the 150,000 metastatic tumors to the brain get operated upon (another 15,000 surgeries) and there are re-operations on recurrent gliomas (perhaps another 10,000 cases). This puts the number of surgical procedures performed on brain tumors in the US annually at about 46,000.
Now consider the number of neurosurgeons - 4,600 (the majority are Board Certified). Dividing the 46,000 procedures among 4,600 neurosurgeons leaves only 10 surgical procedures per year per surgeon! Not a great deal of experience. In fact, most neurosurgeons perform far more surgery for spinal conditions and trauma than they do for brain tumors.
However, there are centers where a neurosurgeon treats 100-200 brain tumors per year. These surgeons are operating on many more brain tumors, while the majority are seeing less than 8 cases per year. Of course, you want the surgeon with the most experience and the best results.
But how do you find them? The Brain Tumor Foundation has extensively researched and continuously updates a list of the most experienced Neurologists, Neuro-oncologists, Neurosurgeons and medical professionals. For more information, call 212-265-2401.
Please note, your insurance company should also be able to help you evaluate physicians.
A word about surgeons: Ability versus Personality Patients and professionals alike often stress the importance of choosing a physician who has a good "bedside manner". However, remember that you're looking for a surgeon, not a best friend. Contact with your surgeon will be brief - about a week or two, with only infrequent follow-ups at a later date.
What you want to look for in a surgeon: quality of work in the operating room, ability to remove the maximum amount of the tumor while causing you the least amount of pain, and attentiveness to your level of health and comfort from beginning to end of the procedure.
Other issues: Geography and Insurance Companies Another issue to be considered is: location. Getting the most competent surgeon to work on you may not be geographically convenient for you or your family. The Brain Tumor Foundation can help if the surgeon you need is not in your city or state. Remember that in many cases the best shot at a successful surgery is often the first one.
Just as important to remember: Do not let your insurance company determine who will be your surgeon. They are in the business of making money. You are fighting for your life. You need the best - not the cheapest. Find the best person to get the job done, wherever that might be. Worry about the money later.
Online: Several websites allow users to evaluate physicians before deciding which to visit. The information available at each site varies, but often includes items such as:
- Educational background and date of licensing
- The practice name, address and phone number of all offices
- The names of other doctors in a practice group
- Legal actions taken against the doctor
- A list of the articles or research papers the doctor has published
- A list of professional and community service activities or awards
- A list of the health plans the doctor works with
- Availability of translation services at the doctor's office
The American Medical Association offers profiles of virtually every licensed physician in the United States and its territories. The site, however, only offers a limited scope of information, such as educational background, contact information, office hours, health plan participation and hospital admitting privileges.
For more detailed information, you may want to visit the following sites.
The Administrators In Medicine (AIM) DocFinder offers profiles of physicians in 20 states with links to profile sites in 5 more states.
Best Doctors' AcuMatch routes patients with critical or complex cases to the best doctors in the United States for a substantial fee.
NEUROSURGERY://ON-CALL® provides access to the websites of the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS)
Recordscheck.net promises detailed profiles of doctors around the U.S. for a fee ($9.95 for basic info, or $24.95 for detailed info).
The following are sites for individual states, usually provided by the state's Board of Medical Examiners: