Are Oncologists Different From Other Doctors?

Neil Chesanow

Disclosures

October 10, 2013

In This Article

Lowering the Wall Just a Bit

Every doctor who sees patients who are suffering and dying needs a way of dealing with it. This generally means erecting a psychic wall to compartmentalize one's emotions to maintain professional decorum. Oncologists are no exception. But perhaps their walls are a bit more porous than most other doctors'.

Fighting cancer breeds intimacy among the combatants. It's tough to spend a lot of time with patients with cancer without things getting a little more personal than doctors in other specialties might be comfortable with or even feel is professional.

"Even in our patients with early cancer, there is an intensity around diagnosis and treatment," Robert observes. "Then the treatment ends, and the need to be seen decreases. Maybe you haven't seen the patient in a few years. And then they come back."

And now that they're back, what are doctor and patient are likely to do? Socialize, kibitz, bring each other up to date. "We spend part of our conversation comparing notes on how each of our families is doing," Robert says.

"The relationship is a professional one," he hastens to add. "Yet you want to show some sensitivity, and you want to connect. You show interest in their families. They reciprocate."

Accepting One's Own Mortality

One stark reality that sets oncologists apart from many of their colleagues in other specialties is that most doctors don't deal with patients who are dying as a lifestyle. Treating patients with cancer is an inescapable reminder of one's own mortality, that for 1 in 2 men and 1 in 3 women in the United States, a diagnosis of cancer is in their future.[6] How does one deal with this day in and day out?

"You take the walk with the patient on their journey, and you go through as a guide and advocate in helping along the way on that journey," Robert believes. "You address your own mortality [he went through his own process, he says] and the fact that everyone dies. You accept your role: If you can prolong someone's life with quality, and if you can give someone another holiday, another year, or a little more time to spend with their family, those are meaningful endpoints."

"If you think you're going to live forever, you'll be frustrated when your patients die," Robert concedes. However, a patient's death does not negate the oncologist's efforts, he emphasizes. The oncologist's role is "to help patients make the best out of a bad deal."

But still, done well, with compassion and tenderness, with doctor guiding patient in making good choices along the way, there is beauty in it.

Robert recalls a patient with breast cancer whom he especially liked. "She really fought her illness with a lot of grace and courage," he says admiringly. "This was an independent woman who went through a number of treatments on clinical trial, and the disease finally caught up with her.

"Amazingly, she was able to pivot from fighting her illness to saying, 'Okay, I can't fight any longer. There are no more drugs I can take or tolerate.' So we tried to emphasize the final part of her life," Robert remembers, "and the quality of hospice care. She was fully aware the whole time. It was just done with a lot of intelligence and caring, and to be part of that was frankly rewarding."

"So, yes, I'm not going to see Cynthia anymore," Robert says. He has made his peace with it, as every oncologist must learn to do. "Part of coping is realizing what my role was," he reflects. "I was there in her life to help her get through a difficult time. She was going to die, but if I did my part well, when her death came, I would feel like I did a good job, even though I couldn't avert death.

"You have to come to grips with the fact," he says, "that there will be an end."

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