One of the universal bits of advice you’re going to get as a patient with multiple myeloma is that you need a good relationship with your doctor.

In a recent article, patient Kay Cromie of Burlington, Vermont, stressed to Myeloma Beacon writer Saniya Tabani the importance of developing a rapport with your doctor, so you can feel comfortable communicating your concerns, asking questions, and discussing treatment options with your doctor.

When I spoke a few weeks ago with Dr. Sergio A. Giralt at Memorial Sloan-Kettering Cancer Center, he said every patient and his or her doctor should have a compact. From his perspective as a physician, the agreement goes like this: “Tell me what’s really important for you and how I can respect that. If I feel I have to break that compact, we will negotiate.”

That, I think, should be the basis of your relationship with the doctors who are treating your disease.

Unfortunately, you may discover that your doctor just isn’t up to snuff, or maybe he or she isn’t even close to being on the same page you are on. Here’s one tipoff: When one of the leading myeloma practitioners in the country snickers in front of you about the way he was treated by the local oncologist you’re seeing, maybe it’s time to start looking around for a new doctor on the home front.

At the risk of causing some consternation among my physician friends, I’m going to repeat this old joke:

What do you call someone who graduates last in his or her class in medical school?

Doctor.

Let’s face it, not all doctors are created equally.

Since myeloma struck me, I have been exposed to health care’s good, bad, and ugly. Now, I won’t say I’ve been particularly surprised about some, or even much, of what I’ve witnessed, given that I’ve worked in the health care field for many years, although not as a practitioner. When your life is dominated, however, by intensive treatments that go on for more than a year and a half, a lot of what you see and experience can be eye-opening.

For example, I discovered a few days before an invasive surgery that I’d picked a surgeon whose license to practice medicine, it turned out, was placed on five years probation for drug and alcohol abuse. In trying to pick a surgeon, there were various people I spoke with, none of whom told me about this major blemish, to say the least, on this otherwise nice, talented man’s record. They all said, universally, what a “wonderful” surgeon he is.

At least, I thought, the New York State Board for Professional Medical Conduct hadn’t taken his license away. They just put a whole lot of restrictions on his practice. A whole lot. For that matter, it was also almost five years after he’d signed a consent decree and did not contest the professional misconduct charge, and his practice seemed to have survived. I needed this surgery to be done on a fast track because the underlying issue was delaying my first stem cell transplant. Not to mention there was a serious health risk that needed to be addressed. So, I decided to go ahead with this surgeon.

I think the bottom line was I needed to avoid any delay, and this man’s reputation as a surgeon seemed to far outweigh his reputation as a former (I hoped) substance abuser. It turned out fine.

What do you do, though, when you have a doctor treating you on an ongoing basis and you don’t have the confidence or rapport you feel you should have? Making a switch is not an easy process, and I fear that because of that, there are many patients out there who decide to grin and bear it. That’s a mistake, of course, but I understand how that works.

Here’s another example, going back before my diagnosis, but when my condition was rapidly deteriorating.

There is nothing funny about the run-up to my diagnosis.

The entire story is too long to repeat here today. And the cautionary word I’ve heard from more than one doctor since is that myeloma, especially given its rarity, can be difficult to diagnose. I also know, however, that my primary care physician was oblivious, spending little apparent time investigating what was wrong with me. Because my kidneys were on a downward spiral, however, he finally had his office make me an appointment with a nephrologist, scheduled three months away. In retrospect, if something else hadn’t been done, I probably wouldn’t have made it to that appointment.

As my condition worsened, I made more than one phone call to my primary care physician’s office and talked with his staff, and at one point, pretty much pleaded for something to be done more rapidly. I was unceremoniously rebuffed. The doctor himself told me he would not even call the nephrologist to get my appointment moved closer. He said to me, “suddenly your kidneys aren’t working so well,” but seemingly refused to consider this an emergency. This may sound mean or cruel, but the insensitivity was pretty unbelievable, and certainly not what you’d expect from a long-time medical professional. When this doctor told me that he’d done “all he could do,” he basically was washing his hands of me and leaving me to fend for myself.

Really, it was only, in the end, the interventions of Linda, my wife, who has been my caregiver and advocate throughout my struggles with this disease, that got things moving. When, a day after she got involved, and we walked through the office door of a hematologist/oncologist, he knew what was wrong with me simply on the basis of blood work and other records that had been faxed to him from the primary care physician. And he said so pretty bluntly. The only thing he needed to do was confirm with the dreaded bone marrow biopsy/aspiration.

In terms of facing the need to switch doctors, my experience with the primary care physician was extreme.

Yet, even when we know we should find another doctor, we often avoid taking up the task. There are many reasons. We might like the doctor, personally. We don’t want to hurt their feelings. It takes time to find a new doctor. There’s a fair amount of research you need to do.

But, you can do it. And here are some things you can do.

First, you need to make a decision about whether your current myeloma doctor is right for you. When you meet for your appointments, is there give-and-take, or do you just listen and nod your head? Does your doctor take time to explain things to you? Does he or she listen to you and answer your questions in terms you can understand? Does your doctor consider different options based on what you say?

You and your myeloma doctor are going to make decisions, hopefully for many years, that will impact your life at its very basic level. These decisions probably will determine how long you will live and what your quality of life will be like. They are going to affect everything else in your life, including your relationships with those you love and how you are going to get on with the rest of your life.

Just imagine if you have the wrong person giving you medical advice.

A lot of people have cancer. And I’m sure you know a certain number of them, or members of their families. Ask the ones going to hematology practices how satisfied they are. Start building a list.

Ask your other doctors for recommendations. You probably have a primary care physician, and you may have other specialists. Call their offices and say you want to speak briefly with the doctor about a recommendation for a new cancer doctor.

When you’ve narrowed things down, find out all you can about your choice, or possible choices. Visit their hospital or practice websites. Get their bios. Check their experience and board certifications. Go back to people you know or other medical professionals and ask, “What do you know about so-and-so?”

Almost every state makes available disciplinary actions against doctors. You really need to check these out. For most doctors, you won’t find anything troubling. Or there may be things that aren’t serious enough to sway your decision one way or another, but you need to consider them.

There are websites such as healthgrades.com, where you can pay for information, most of which you can hunt down from other, free sources, and there are various websites where you can find opinions about doctors. Nearly all of these sites rely, in part, on consumer comments and ratings. Personally, while I might look at some of these, I try to keep negative comments in perspective. An occasional bad experience can translate into something overwrought and overblown in cyberspace.

Ideally, you’d like to have a chance to talk with your prospective new doctor before making a commitment. Realistically, that’s not likely to happen. Your first meeting is going to be at your initial appointment. I think, though, if you’ve spent the time on your research, you’re going to find the right doctor, one with whom you can establish that all-important rapport.