People diagnosed with cancer spend a lot of time with their oncologist. I have no doubt that the most important part of their treatment is that they find an oncologist in whom they have total confidence.
When I meet with my patients, I make it a point to create a trusting, uninterrupted, almost sacred environment for them. When the clinic exam room door closes, the outside world stops existing for as long as they need and the only thing left in my universe is my patient. I silence my pager and give you all the time you need. Then I listen.
I want to have a strong personal relationship with my patients. I want to know their dreams and fears. I want to know what they like to eat, how their kids are doing, and where their next vacation will be. Not only do I find the connection we make together to be immensely rewarding, I believe this relationship helps heal the cancer patient.
Will machines replace doctors?
Advancements in technology are staggering, with many new drugs now on the market. We can have radiologists from the other side of the country instantly look at scans for a second opinion. Analyzing a tiny fragment of a tumor less than half the width of a human hair tells me about hundreds of genetic mutations, which then helps me pick cancer pills or experimental therapies.
When I was a medical student, I used words and my hands to make most of my diagnoses. Now, technology replaces much of that human interaction. The positive part of that is that it gives us a more accurate diagnosis and sooner.
So I wonder if I’ve just become a technician, if someday soon a supercomputer or an app will be able to pick better drugs for a cancer faster than I could. In the future, will patients just stick a needle into their lump, and their cellphone or “Dr. Google” will tell them the best chemotherapy for the cancer to pick up from the pharmacy aisle?
If artificial intelligence provides perfect knowledge, wouldn’t robots make better doctors? Oncologists take a long time to train, we can make mistakes, and we go on vacation occasionally. Might it only be a few years before some startup makes my job obsolete, the latest profession replaced by machines? How can I justify to the world the value in what I do?
A machine can’t root for you
The way I think about my job is that even if technology can tell you the best treatment for your cancer, by forming a close bond with patients I can still come up with the best treatment for YOU.
If your goal is to look REALLY great next summer for your daughter’s wedding, I can give treatment that will control your cancer but won’t affect your skin or your hair. If I know your main worry is to not feel nauseous and fatigued, I can give you chemo that is only a little less aggressive on the cancer but a lot gentler on your body.
I think of myself as an aggressive oncologist, but sometimes giving more chemo can be the wrong answer. If it ever reaches that time to focus more on quality of life rather than endless cycles of chemotherapy, I can definitely help people make that choice better than a supercomputer.
And when I am with my patient in clinic, I do what healers have done for thousands of years before me. I hold your hand, I give comfort through words and silences, and I look you in the eye as I would any other person – not a sick patient to be pitied. I share your joy and your pain, and, just like you, I have my weak moments and then I rise. I know what it means to have unfulfilled dreams, and how unfair it is to have cancer when you exercised and ate right.
Most important: When things are grim and you are getting your affairs in order for the final time, being flesh and blood I will understand what you’re going through better than any microchip.
A machine can’t root for you, but we can.
Communication is two-way
When talking about cancer treatment, I want the dialogue to be open and honest (for example, as an oncologist I write many prescriptions for Viagra). By spending more time learning about my patient’s life, I get insight into their disease and can pick better treatments. Perhaps a patient smoked for years and never told his or her spouse or friends. In that room, I want him or her to be able to tell me because that can affect your treatment. Trusting your doctor enough to be honest with them will help you.
As physicians, we spend decades learning about cancer. We are scientists, but it is seeing the real-world, human impact of cancer that inspires my colleagues and I to develop new technologies and techniques that we hope will revolutionize treatment.
The language we use can sometimes overwhelm patients and that jargon sometimes slips into our everyday conversations. I believe the better I am at communicating with my patients in a relatable, simple way – a way that incorporates their feelings – the better my patients will be able to decide the best treatment for them and to understand their diagnosis. When I spend time making a personal connection with my patient, I find they are more comfortable interrupting me to ask for clarification or more details.
This personal relationship that you share with your oncologist is both physical and spiritual. When I examine my patients, listen to their heart, look into their mouths, I am very aware that I have been given a very special privilege by my patients. While I’m healing their body, it’s also a great honor to be granted a glimpse into my patient’s soul.
We’re on your side
Finally, I consider my patient’s battles to be my battles. Working on their behalf and using my experience to prevent problems is why I get up every morning. It is what my colleagues and I have chosen to devote our lives to, and there is absolutely nothing else I’d rather be doing. Because we love our patients, we are thrilled for each patient’s victory, and share their disappointments as if they were our own.
The best cancer doctor is one you never have to meet professionally. But if you are diagnosed with cancer, I encourage you to let your oncologist know who you are. It will definitely make things easier for you, and you’ll also help your doctor be better.
Barry W. Uhr (1994) Dear Doctor in the Year 2040, Baylor University Medical
Center Proceedings, 7:2, 38-38, DOI: 10.1080/08998280.1994.11929867