Are Oncologists Different From Other Doctors?

Neil Chesanow


October 10, 2013

In This Article

When Doctor and Patient Disagree

Despite the oncologist's best intentions, the doctor-patient relationship may not always go smoothly. There may, at times, be sharp disagreements on how best to proceed. In fact, intrinsic cycles of agreement and disagreement tend to exist.

"Oncologists are generally pretty enthusiastic about treatment early on, and that's often when patients are not," Patel explains. "We start by doing our rah-rah thing to get them going, and then we move onto a plane where truly our desires and intentions and those of the patient merge, and then doctors and patients often diverge again at the end of their trajectory, when most physicians would do less and focus more on the patient's comfort, and patients often want to do more.

"The ideal physician-patient relationship in oncology would be that intention and desire are similar throughout that whole arc," Patel says. "But certainly at the beginning and at the end we're often not in sync, and that can be difficult."

Many patients come to Patel with vivid memories of a friend or relative who died a slow painful death from cancer way back when, with the drugs being almost as debilitating as the disease. "How will I live with cancer?" they want to know.

"We coach them through it," Patel says. "'It's so different now,'" she explains to patients. "'You'll be working. You'll still be taking care of your family. We'll get you there.'"

But a time may come when the cheerleading needs to stop. "Often when we're saying that the therapeutic window is tighter again, and you'll have more toxicity, patients don't understand," Patel concedes. "They feel like we're giving up. That's when we separate in our sensibility."


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