The Cheerful Oncologist

[Editor’s Note: this is an entry in an occasional series; parts I-IV can be found here.]

If one needs a bit of cheering up these days, say after inadvertantly watching one of those cable talk shows, here’s a suggestion: read about the medical advances made since the end of World War II. They are numerous and impressive. Despite the well-documented inequalities in disseminating proper care to the world’s unhealthy one forgets that just a few decades ago there were no effective treatments for a multitude of diseases.

Only a nihilist would refuse to acknowledge that we are living longer and healthier lives with the help of modern medical drugs and treatments. Of course the nihilist has a secret weapon in his argument: the death rate is 100% on this planet and will always be 100% until the last upstanding citizen of Earth croaks, at which time it will once again revert to zero (cf. Cretaceous-Tertiary extinction event). Why, therefore, do we spend so much time, effort and money on improving our health just so we can die in the thrall of desuetude? [How about: because it beats the alternative? -Ed.]

This assumes that all of us are going to live to be hoary old gnomes, which is untrue. Taking good care of one’s body does not guarantee a long life – just ask any non-smoking patient with lung cancer. As often as rain falls from the skies do patients reach that point in their illness where their doctor says “There is nothing more I can do for you.”

If you ever hear that phrase, remember this: it is a lie. Physicians who tell their patients this may actually mean “I’m getting depressed watching you die and want to avoid you,” or they may think of illness as a contest of skill where only victory has any value, and defeat must be acknowledged by immediate sacrifice of the vanquished. In either case what they are really saying is that they are losing interest in caring for you. This attitude may be a sign of insensitivity or simply a human reaction to an impending sadness, but it is still wrong and can be corrected easily and gently as follows:

If you ever hear your doctor state that there is nothing more that can be done, turn to him or her and say “Then now is the time I need you the most.”

Comments

  1. #1 DrDork
    January 3, 2007

    Very well put. A countertransference we often miss.

  2. #2 emmy
    January 3, 2007

    Then what, after a doctor has said that and you tell him or her to stick around to the end? What is left that they can do? If some one is getting depressed watching you die, is it reasonable to insist that they do? As you said, the death rate on this planet is 100%. But some of us have pretty sad deaths. If a loved one or a doctor isn’t willing to stick it out, should they be compelled?

  3. #3 Calli Arcale
    January 3, 2007

    No, but it doesn’t hurt to ask.

    Thing is, a lot of the time when doctors say this, there really is stuff they can do for you. But curing you is no longer one of them, and that can be very disheartening — not only because of pride, but because they think this is what you want. They think they have failed you.

    So a good response really is to say that no, you do still need them, and there is still something they can do for you, even though you know they can’t cure you. They can help ease your suffering. Palliative care. In many cases, there are still options available for prolonging life, or for making what life remains as pleasant and productive as possible. If they can give you a therapy which, while not a cure, will restore enough of your energy that you can take that world tour you’ve always dreamed of, that’s huge. It’s certainly a lot more than nothing.

    And many doctors are cheered enormously when they realize that their terminal patients realize and accept their situation but can still be helped in other ways.

  4. #4 The Ridger
    January 3, 2007

    Also, “there is nothing more I can do for you” will almost certainly be understood as “there is nothing more anyone can do for you”, unless it’s immediately followed by a referral. So, no, no-one should be forced to stick around and watch someone die, but neither should a doctor be allowed to simply abandon his patient. There’s always someone who will take them on.

  5. #5 Justin Moretti
    January 3, 2007

    For a lot of doctors I think “There is nothing more I can do for you” means “There is no longer any hope of cure or long-term control.” The problem is that the statement is not adequately qualified for what it means, and the patient feels abandoned.

    A good example is the patient with a metastatic solid tumour for which palliative chemo and/or radiotherapy might be appropriate. In my practice as a junior registrar (Australian public health system) I would offer consults to both as clinically appropriate, even if the patient was dubious or unwilling, on the grounds that (as I used to explain to the patients) if they are going to reject these therapies, that is their business, but they should do so based on information ‘from the horse’s mouth’ (chemo- or radio-oncologist).

    Had I gone on to be a surgical consultant, and had my patient rejected therapeutic or palliative chemo/rays, I would have said, “You must realise there is nothing more we can do surgically. Nevertheless I will follow you up in the usual postoperative routine, and if you start to have symptoms you can’t easily control at home, come back to see me and I will at least find ways to make you comfortable.”

  6. #6 epador
    January 3, 2007

    The phrase as I’ve heard it used most often reflect the CO’s observations. Personally, if I had a doctor that talked like that to me, I wouldn’t waste too much of my time trying to console them or educate them. Nor would I be willing to trust them with my care for my limited life span. If they are that self-centered or ignorant, its time for me to find a new doctor.

    The arrogance of the statement is overwhelming.

    It also is a sad demonstration of one of several failings of provider-centered health care systems versus patient-centered health care systems.

  7. #7 cheryl
    January 4, 2007

    I must be very fortunate, because my Onc and me have discussed this issue before. She is with me until the end, God willing…….and will take care of me, when I decided to quit chemo or she thinks it won’t do any good. You have to remember that this is my eighth year of ovarian cancer and I have been in and out with many chemos.
    I totally trust my Oncologist and consider myself blessed, that she has never lied, or sugar coated the truth, yet still gives me the illusive hope for tomorrow.
    Cheryl p

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