I prefer my physicians to be older men with slightly jaundiced eyes. The enthusiasm of youth frightens me; and fanatical devotion to "saving lives" terrifies me.

As long as I'm giving advice about human cancer, I might as well go the whole hog and give the public the secret that the medical profession guards zealously. Many people have found this secret on their own; but some extremely intelligent people still believe that the best way to find a good doctor is to call the County Medical Society; which it isn't.

A recommendation from a number of people who have been treated successfully can often help, but is not the most reliable method in the world. Many years ago, I was bothered by hemorrhoids, which I anticipated having to have treated surgically. I inquired of people with similar complaints, and they unanimously referred me to a well-known local proctologist. Their recommendations were all the same, "He is a wonderful doctor, and does great work, but I had to be re-operated twice."." The recommendation was always glowing and the results of the surgery were always wanting. I ended up being reamed by a competent general surgeon who didn't like doing hemorrhoidectomies. I haven't been troubled with the problem since.

First of all, let us assume that your physician, no matter how competent or incompetent he is, still knows more about what is available medically than you do. The same holds true of senior residents in large hospitals.

How do you get an honest physician to give you an honest answer? If you ask the question, "Whom would you recommend to do a ...........ectomy on my aging father?" the answer will usually be a local physician who refers patients to him and with whom he plays golf. This may be a perfectly reliable recommendation, since he is not likely, being an honest man, to recommend someone who is totally incompetent. On the other hand, there are varying degrees of competence (or incompetence, Dr. Peter). A better way of asking the question, which puts the doctor in a spot, since he either gives you an honest answer or has to live with his conscience for a less than honest one, is, "If your father needed a .........ectomy, to whom would you send him?" This is more likely to get you the doctor you are looking for; the most competent man in the area. If you happen to be living in a small town and don't have a physician you trust, a good bet is to corner the chief resident in the local large city hospital. He is forbidden, by professional ethics, to refer you to anyone; but if you make it clear that you're not asking for a referral, but simply asking an academic question such as "Who would you go to if you needed a .......ectomy?" you may be able to get an informative answer. Any of these methods is better than using the yellow pages.

It is now dogma that a person should see his doctor once a year and receive a physical examination. Obviously, walking up to him and saying "Hello doctor" and him answering you does not constitute an examination. There are also examinations that would take the examining physician many hours, and would involve hundreds of dollars worth of x-ray and laboratory work. If a person feels that he is in good health and has no outstanding complaints, there seems little point to going to any massive expense. There are, however, a few things in a physical examination that are simple and relatively harmless; and if something is found it might save the patient's life. Much of the credit for the reduction in death from cancer of the uterine cervix can be attributed to the use of the so-called Pap smear, which can detect cancerous and precancerous conditions at times when they are easily treatable. Men and women (particularly those over forty years of age) should have a finger examination of the rectum. The finger can detect half of all tumors of the large intestine. It can also detect tumors or abnormalities of the prostate gland in the male. Many physicians prefer to use a sigmoidoscope, which is an instrument that enables the physician to visually examine the rectum. It can detect two-thirds of all tumors of the large intestine. With cancer of the bowel, the earlier that it is discovered, the better the patient's chances; and it goes without saying that if they are discovered before there is any discomfort, it's even better. If, in the course of the routine examination, a physician does not do a Pap smear and examination of the breast on a woman, and a rectal examination of some kind on people of both sexes, the patient is not getting much of a physical. He is probably wasting both his and his doctor's time.

Beware of physicians who promise a cancer cure. They are either trying to con you, or conning themselves. In either case, the results can be disastrous. The honest professional can give you some estimate of the odds, but that is the best he can do. In some kinds of cancer, such as early basal cell carcinomas of the skin, the odds are very high. It almost approaches certainty of a cure with tumors of less than a half an inch in diameter. The smaller the tumor the better the prognosis. With a larger tumor, your physician has no way of giving that much assurance.

Given accurate information, people are generally able to make rational decisions. Unfortunately, accurate information with regard to cancer is hard to obtain. We usually have to settle for the best "educated guesses" that are available. It is a good idea, therefore, to check out information that involves life and death decisions, before acting on it. This can often be done by obtaining a second opinion. Competent physicians encourage this. They encourage it because they are aware of their own fallability, and would prefer to share the responsibility for a potential wrong decision. One of the best reasons for seeking a second opinion is if your physician objects to it. If he objects, make sure that the second opinion comes from someone who is not associated with your doctor.