2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

imperfect human beings, who in their relationships with
patients may at times fall short of their own best intentions
and at other times reach profound moments of harmony.
Does experiencing illness personally make one a more
humanistic physician? Perhaps for some the answer is yes,
for others no, but for all it is a possibility. Regardless, it is
important to generate dialogue about the humanistic element
of medicine because it is fundamental to patient care.
As the noted physician William Osler (1849–1919) eloquently
stated, “Care more for the individual patient than
for the special features of the disease ...Putyourself in his
place ...Thekindly word, the cheerful greeting, the sympathetic
look—these the patient understands.”
Martin Raber, MD: The Oncologist as the Patient
Without question, being a physician has influenced my
experience as a patient and being a patient has influenced
my experience as a physician. I am not sure that it has made
me a better physician, but I know that it has made me a
different physician. It has also given me a different view of
the clinic, the hospital, and the medical teams. At the same
time that I have been a patient, I have also tried to maintain
a semblance of an academic career and continue to see
patients in my area of expertise. This has been possible only
because my institution and my colleagues have been willing
to make substantial accommodations to limit my responsibilities
and to cover me whenever I was unable to work.
I don’t think anything prepares you for being sick, and the
experience of entering the hospital as a patient is so incredibly
different from that of entering it as a physician that, at
first, one is totally disoriented. As physicians, we tend to
think of the hospital and clinic experience as centered on us.
Although it is true that the physician’s decisions and comments
are what drives the delivery of care, in many respects
the patient experience is driven by the ancillary personnel.
KEY POINTS
● A personal experience with illness provides a unique
opportunity for the physician to gain considerable
insight into the humanistic elements of medicine that
are at the core of patient care.
● The patient experience is very much dependent on
interactions with the ancillary staff; how they treat
each other and how you treat them is as important as
how they treat the patient.
● Physician-patient communication is more difficult
than it seems, particularly in areas in which we do
not have lab tests, images, or clinical findings to
explain the situation.
● Caring for patients while also being a patient is a
challenge; it requires substantial accommodation on
the part of one’s colleagues, team members, and
patients.
● A physician who is the relative of a patient with
cancer may struggle with distinctive challenges that
relate to the intersection of the physician’s medical
knowledge and personal emotions with family
dynamics.
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GILEWSKI, RABER, AND SLEDGE
Patients spend most of their time with clinic and chemotherapy
nurses, clerks, radiology and laboratory technologists,
patient transportation personnel, and others that we tend
not to consider as central to the patient experience. If they
don’t deal with the patient in a positive way, the patient
experience is not good. This has to do with not only how they
deal with the patient but also with each other, and how you
as the physician deal with them. Good communication skills
are important not only for the physician but also for everyone
who interacts with the patient.
Patients see and hear everything that goes on. We sit in
the waiting rooms and observe the interactions and process
what we see. Even in the examining room we hear the
conversations in the hallway between physician and nurse or
trainee. Sitting in a waiting room (which is what we patients
do a lot of) I am always amazed at how perceptive my fellow
patients are about the staff and the clinic operations.
Another surprise to me as a physician was the difficulty
that I have had at times communicating with my medical
team. This related most often to symptoms or situations for
which there was not a good laboratory or radiologic corollary.
I have come to believe that the doctor-patient visit in
the clinic is much more stereotyped than we think. Although
the physician wants to find out how the patient is feeling,
assess the patient’s condition, and give the patient information
about his disease and plans, and the patient wants to
tell the physician how he feels and understand his condition
and the plans, there is tremendous opportunity for misunderstanding.
Patient and physician have somewhat different
goals and expectations of the clinic visit. They also have a
conversation in which many words are used without prior
agreement as to their meaning. “Good,” “bad,” “fair,” “tired,”
and “alright” are examples of words that may mean very
different things to the patient and the physician. That
realization caused me to substantially change the way that
I interview patients in my clinic, and the way I speak to my
physicians in their clinic.
Trying to maintain a medical career at the same time one
is facing serious illness, and undergoing cancer therapy, is a
challenge. Early in the illness I had what I call “doctorpatient
confusion,” and was unable to practice at all. Later,
after I recovered from some devastating complications, I
found that I had passed through that phase, and once again
began to see patients. In this period I have come to realize
that my illness has had a major effect on my colleagues who
have often been simultaneously my colleagues and physicians,
on my team, and on my patients, all of whom have had
to adjust to the realities of my health problems. As have I.
George Sledge, MD: The Oncologist as the Relative
of a Patient with Cancer
Because cancer is common, and because cancer doctors
have relatives with cancer, cancer professionals regularly
come face to face with cancer in relatives. Their unique
perspective on cancer—a perspective that has both intellectual
and emotional components derived from years of caring
for patients with cancer—clearly affects how they interact
with those relatives, both for better and worse.
Physicians are routinely taught to avoid taking care of
relatives, an admonition that is both wise and rarely
completely respected. Wise, because physicians need to
maintain emotional distance from their patients. Every
relationship with a relative is fraught with family history,