By Richard Frank, MD
In response to my last post, I heard from many of you about both good and not so good experiences with cancer doctors and cancer centers. Certainly, every cancer patient needs and deserves compassionate, empathetic care. Some doctors are better than others in practicing with compassion on a daily basis. On the other hand, some doctors do understand and feel their patients’ pain and suffering but are unable to convey this to their patients. Still others may have become immune or “burnt out” and leave their patients wanting more; they are viewed as lacking compassion. In this post, I will talk from my own experiences about the difficulties of being an oncologist and why sometimes oncologists may not seem compassionate.
Being compassionate is something that comes naturally to me as it does to other human beings. I am a people person and revel in the differences and similarities amongst us. In my role as an oncologist, I must face a fellow human being who has come to me for help because he or she is facing a potentially life-threatening illness. This is a terrifying feeling. It is a natural reaction to care; I would say that all oncologists feel this way or they would not be in the field. I realize that this person had an entire life before being forced to see an oncologist. Their life was buzzing along, whether wonderfully or problematically, happy or sad, it was their life to lead. Then cancer intruded and stole all the attention, derailing their life. And now I am the one this person hopes will fix the situation. But I am not part of their past life, I am part of the present hardship thrust upon them. Some patients appreciate that I am a fellow human being trying my best to help them. Others, not on purpose, lump me in with the cancer and blame me for the situation, whether consciously or unconsciously. I am aware of being evaluated and that every word I utter is scrutinized. Patients hope that I shall be calm, measured, caring, reassuring, hopeful but realistic, honest but sensitive. I am expected to know all the answers they have about cancer. It is not an easy bill to fit.
Sometimes I am appreciated for my efforts and sometimes I am not. Many of my patients do, I believe, respect how hard I try for them, and they communicate their appreciation. Yet, sometimes it is just not a good mix; I don’t easily jive with a patient’s way of thinking or speaking or acting. It is no different than in everyday life: There is a need for a good fit. And it behooves the doctor to adjust as much as possible to what he perceives the patient needs. Again, a very delicate task. A cancer patient and their oncologist need a good, trustful rapport. Sometimes the relationship starts off rocky and the patient moves to someone else. Some patients try out several oncologists before deciding on one and some juggle more than one, at times playing one off the other. There is simply more to it than how I or any doctor acts because every patient brings a lifetime of experiences, expectations, and their own biases. It is impossible for any doctor to perfectly adjust to everyone all the time.
I have seen too many patients struggling to live and lost some patients for whom I have cared a long time. These losses affect me and I have written about this in an article entitled, “The Fragile Bonds of Cancer.” Certainly there are many victories and wonderful stories of survival and joy. But I must, by necessity, revel only briefly, for my energies are needed where patients are struggling most: those dealing with incurable situations or severe side effects from treatment. Always, there is more to do than there is time to do it, more care to give out than I could possibly give and more knowledge to impart than can possibly be absorbed. (It is for these reasons that I spent five years writing my book, Fighting Cancer with Knowledge and Hope). At times these awesome responsibilities can lead to fatigue and the feeling that I am not able to give my very best at that moment. It may appear like I don’t care enough, but I truly do. I look around and see that my colleagues are mirrors of myself. I am not alone.
So please folks, have a little more compassion for the oncologist. I would never, ever excuse rudeness or coldness or a doctor who does not try to give each patient the time they need. But the oncologist’s job is not an easy one and sometimes we need a little slack (my patients give me a lot of it and for this I am truly grateful!). Certainly, it cannot compare to being the person affected by cancer, and we should never lose sight of that. Yet, it is surprisingly healthy for the doctor-patient relationship when the patient verbalizes an understanding and empathy for the hard work of their oncologist. It also helps to be frank with the doctor about any shortcomings you perceive in their behavior and clearly communicate which needs of yours are not being met. If these measures fail to improve your unfavorable impressions of your oncologist, then certainly a change may be a good thing. In the end, forgiveness and compassion on both sides of the stethoscope will be of benefit to all.