2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

The Oncologist as the Patient with Cancer or
Relative
By Teresa Gilewski, MD, Martin Raber, MD, and George W. Sledge Jr., MD
Overview: To an extent, physicians are familiar with the
consequences of illness through their interactions with patients.
However, when cancer becomes personal, the physician
has an opportunity to gain greater insight into the
intricacies of medical care, including its humanistic elements.
Physicians who encounter cancer in themselves or in a relative
may deepen their understanding of the patient experience.
PERSONAL EXPERIENCES may influence an individual’s
thoughts and actions. It is plausible that a physician’s
perspective of patient care may be affected by an
encounter with illness on a personal level. Any human being
who is sick or who has experienced illness along with a
family member or close friend has the opportunity to gain
considerable insight into the complexities of medical care.
This may be especially true for physicians who have the
unique position of viewing patient care from the perspective
of the provider as well as the recipient. In particular, the
humanistic aspects of medicine may become more apparent
and more meaningful. Human interactions form the core of
patient care, and optimal patient care requires adequate
observation and self-reflection of these interfaces.
Teresa Gilewski, MD: The Humanistic Side of
Medicine—The Impact from a Personal
Cancer Experience
The practice of medicine is a complex interplay of science,
humanism, business and social policy. During different
periods in history, the emphasis on these various elements
has shifted. For example, many of the basic moral and
ethical tenets of medicine were established by Hippocrates
and others in ancient Greece at a time when there was
limited scientific knowledge. 1 With the onset of new scientific
discoveries, a greater focus on technology and science
was inevitable. In 1910, the noted educator Abraham Flexner
emphasized the importance of both a scientific and
clinical research basis in medical education. 2 His report
helped to restructure medical school curriculum to one that
was more research focused. However, 15 years later he felt
that “scientific medicine” was “. . . sadly deficient in cultural
and philosophic background.” 3 Finding a balance between
the scientific and the human components of medicine remains
a challenge to the present.
In addition, now there is an ever-increasing presence, on a
daily basis, of the business and social aspects of medical
care. The humanistic aspects of medicine have often become
secondary to these other more easily measurable facets of
medicine. However, in the last decade medical groups, such
as the American Board of Internal Medicine and Institute of
Medicine, have underscored the importance of practicing
medicine in a humanistic manner. 4,5 The association between
professionalism and humanism has become clearer. 6,7
Yet, there are many challenges, both on institutional and
personal levels, that may hinder the incorporation of a
humanistic approach into patient care. These include the
emphasis on research and greater clinical productivity as
well as the stresses associated with caring for ill patients. 3,8
Their views provide a unique perspective, on the basis of the
convergence of their medical knowledge and personal reaction
to illness. They also confront distinct challenges specific
to their work environment. An enhanced recognition of their
viewpoints provides valuable information in the quest to
alleviate patient suffering and explore the fundamentals of
patient care.
The medical literature contains heartfelt essays that focus
on the importance of human interactions in medicine. 9,10 In
particular, the sections “A Piece of My Mind” in the Journal
of the American Medical Association and the “Art of Oncology”
in the Journal of Clinical Oncology provide physicians
an opportunity to contemplate various aspects of the personal
impact of illness. 11-13 Narrative medicine utilizes the
practice of writing about patients’ experiences and the
writer’s reflection on those experiences to foster empathy. 14
Physicians usually develop a general awareness of the
difficulties that patients confront, but not necessarily a true
understanding of those struggles. However, physicians who
encounter cancer in themselves or in a family member
develop a new intimacy with illness. 15-17 This altered relationship
with disease may result in a heightened awareness
of the consequences of sickness. 18 Once there is a personal
connection with cancer, the day-to-day routine of the medical
system may assume a fresh look. What may have seemed
trivial and of little significance may become momentous.
Some of the usual inconsequential basic human interactions
between a patient and the physician suddenly become memorable
for their compassion or lack thereof.
Experiencing cancer on a personal level may provide the
physician with new points of reference that have the potential
to influence one’s perspective of patient care. These
experiences may originate not only in adulthood but in
childhood as well. In childhood, the effect of caring for a sick
relative and observing the interactions of adult relatives and
physicians coping with illness may be long remembered.
This child who later becomes a physician may use some of
these observations toward the care of patients. Of course,
each physician brings a unique personality and other life
experiences to every situation. However, exposure to personal
illness has the potential to enhance the physician’s
appreciation of the fragility and uncertainty of life as well as
the value of kindness.
The physician’s appreciation of the “human” experience
surrounding illness may be heightened, not only in regards
to patients but in regards to colleagues. Perhaps on the basis
of this greater awareness, a deeper recognition of the essence
of physicians may develop. Specifically, that they are
From the Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson
Cancer Center, Houston, TX; University of Indiana, Indianapolis, IN.
Authors’ disclosures of potential conflicts of interest are found at the end of this article.
Address reprint requests to Teresa Gilewski, MD, Memorial Sloan-Kettering Cancer
Center, 300 East 66 th St., New York, NY 10065; email: gilewskt@mskcc.org.
© 2012 by American Society of Clinical Oncology.
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