Expectations and Preparation for Your First Surgeon's Office Visit

By Dr. Russell Novak, Surgeon
The most common referrals for breast disease evaluation are either for diagnosed breast cancer or the suspicion of breast cancer.  Typically, the referral follows an abnormal exam or diagnostic test by your primary care giver, gynecologist, or often a self-referral following an abnormal self-exam. I see a range of patients – from those with results from multiple tests, including biopsy results, to those patients who’ve had minimal pre-evaluation but who have been prompted to see me by anxiety-driven self-exam findings.
My first recommendation is come prepared — but open minded. I see too many women with high expectations of an immediate in-office procedure, biopsy, or who surprisingly, expect a definitive procedure same day.  The surgeon must first gather relevant history, data, test results, and patient feedback to form an individualized treatment plan for each new encounter. With this is mind, bring everything you have in terms of studies, test results, family background information and personal medical history. The surgeon hopefully has had this forwarded to the office-but not always.  Recently, most x-ray, ultrasounds, and MRI studies are disc formatted and easily hand-carried and reviewed on a laptop. Frustration develops when the patient’s issues can’t be answered due to lack of complete data available.
An office visit with me includes a face-to-face interview, review of all medical records, a complete breast exam and formulation of a treatment plan. Patients never regret having a companion along to “remember” things, ask questions that may not come to your mind, and offer emotional support. Prepared questions are never inappropriate. On the contrary, they stimulate discussion and reduce anxiety, so have that pad and pen ready. The surgeon must listen as well as direct the interview.  The patient must listen, have an opportunity to be listened to, and never expect all points resolved at the first appointment.
Occasionally, an office-based biopsy will be performed at that first encounter, but more commonly, further studies or an outpatient procedure will be arranged that day, in a timely fashion.  Unfortunately “a timely fashion” has many different meanings to different people.   “Yesterday” seems not soon enough for most patients. “As soon as possible” is the surgeon’s goal, and the “system” fits it in somewhere just beyond that timeline.  I don’t believe a patient has ever regretted having enough time to be sure all questions are responded too, all appropriate tests are underway, and any other opinions/consults have been explored before final decisions are agreed upon.
Breast cancer treatment is a team approach!!  In my mind the team includes the patient, her family or support group, her surgeon, a medical oncologist, frequently a radiation oncologist, and perhaps a reconstructive plastic surgeon. Each member becomes a player, but not always in a set order, nor do all continue throughout the entire treatment time. The patient meets each member commonly “for the first time” and needs confidence and (maybe) a sense of security in that relationship.  Some members provide only a single visit for expert input; the surgeon may actually be involved with several procedures that are diagnostic, therapeutic, or definitive treatment.   The radiation therapist may not become part of treatment or treat for anywhere from one to six weeks and may then have follow ups for months. A plastic- reconstructive surgeon may not be needed at all, be a critical component of a surgical procedure or be needed to help decide only after an office consult and exam offers educational information, i.e.-tells the patient about plastic surgery options.  Most commonly the medical oncologist is the “long term” manager, the follow-up physician, but also can play an early role in treatment planning.  I want all patients to remember one thing –  be comfortable with who is involved in your care and is willing to listen.  If you don’t feel comfortable with your team member, find the physician substitute that you can have that relationship with.  Never second guess the appropriateness of the “second opinion”, if you feel you need one, time is there in the treatment schedule.
The first office visit may not always be the scariest, or the most fulfilling in answering all those anxious questions, and may not end up with the physician you ultimately choose, but it can be the start to the formation of a patient physician relationship that most empowers you through your fight with breast cancer. I have found most patients get a sense of that patient/doctor bond formation or lack of it early on.  Come prepared, be calm (yeh- right!!), listen, be proactive in your treatment plan, and listen to your heart.
Dr. Russell Novak, Surgeon


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