Are Oncologists Different From Other Doctors?

Neil Chesanow


October 10, 2013

In This Article

An Intense Doctor-Patient Relationship

If oncologists are different from other physicians, in no small part it's because they respond to the needs of patients with cancer, and, they believe, patients with cancer are different from other patients. There's nothing like a diagnosis of cancer to concentrate the mind. After the shock and the tears, the hunger for information -- on therapies, side effects, prognosis -- can border on ravenous.

"I had a eureka moment some time ago that my patients and their families are now like students who are just really interested, thirsty, eager to learn," says Robert. "I've learned that if the patient keeps asking a bunch of questions and goes on the Internet looking for information, that's okay. I just tell them, 'Watch what you read. But I enjoy your questions. And that's part of my job: to answer them.' My job is to listen and answer questions to direct and provide care."

In oncology, educating the patient is a core responsibility of physicians, and patient education is extensive and ongoing -- unlike, say, primary care, where patient education can be perfunctory, if it is done at all, and is commonly delegated to nurses to keep the doctor on schedule.

"In oncology, in some ways, patients are needier and looking for someone to guide them," says Patel. "As an oncologist, my patients will always refer to me as the quarterback for them and their care. I guide patients through dealing with what many other specialists tell them. In many ways, we take over for our primary physicians -- not for 15 years; more likely it's for 2. We coordinate care and help patients make decisions."

The oncologist provides the education needed to make an informed decision. This guidance is based, ideally, on the doctor's holistic knowledge of the patient as an individual: the patient's personality, lifestyle, preferences, tolerance for one set of adverse events vs another, concurrent medication regimens, and more. This involves a great deal of listening, communication, and thought and is probably deeper than many doctors in other specialties want -- or perhaps need -- to get to know their patients and their patients' families, oncologists observe.

"How an oncologist thinks through the value of complex and harsh treatments demands not only an understanding of science but also a sensibility about the soul -- how much risk we are willing to take and how we want to live out our lives," writes oncologist Jerome Groopman, MD, Dina and Raphael Recanati Professor of Medicine at Harvard Medical School in Boston, in his 2007 exploration of medical decision-making, How Doctors Think.[5]

But often the choice is subjective: Which therapy is the lesser of 2 evils? Ultimately the patient may need to decide based on which agent is likely to be the most tolerable and interfere least with normal activities of living. The oncologist informs that decision, but the buck stops with the patient.


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