Ethics vs Ego

Oncologists have the ability to have a great influence on many lives. They can sit back and play it safe with no exposure or with a little effort, they can cause many patients and their families to be tremendously benefited psychologically and possibly physically.

My niece, in her mid thirties with a small child, was diagnosed in a small town with breast cancer with mets to her bones. Her doctor referred her to an oncologist who held out no hope for survival. Her husband took her to a major comprehensive cancer center for a second opinion. There the oncologist stated that chemotherapy might keep her alive from two to five years but he was uncertain if it was worth going through the agony. The young couple cried all the night and finally faced the reality that she would not be around to rear her children. Her husband had watched his mother painfully die from breast cancer some 20 years ago, so he realized what was in store for her.

They were shaken at the initial diagnosis, but they realized that their physician was not a trained cancer specialist. Then when the oncologist predicted doom and gloom, they were again upset but they realized this was only one opinion. Then when they went to a major cancer center and talked to one of the supposedly knowledgeable physicians trained to the utmost and he confirmed there was no hope, there was no place else to turn. They had reached the ultimate resource! There was no other place to appeal.

When I heard this on a Thursday night, I suggested they call an oncologist some 2,000 miles away who is reputed to be a top breast cancer physician. He insisted she come to see him the very next day. After consultation and tests, he decided to treat her immediately. She received her first course of chemotherapy within 24 hours of the phone call. He told her that with the aggressive treatment she would be getting, she probably had an 80% chance of complete recovery.

I am not speculating whether she will get into remission or not, but based on this physicians reputation, it would be a good bet. At least the ray of hope gave her the will and desire to fight. What I do know is that win, lose or draw, the quality of life for this young lady yesterday, today and tomorrow is far, far better than it was. Her husband is equally thrilled and happy as is her family and friends. What a difference a few words and a little humility can make!

This oncologist recommended she take chemotherapy from the original oncologist rather than commuting 2,000 miles. They chose to travel the two thousand miles because they felt the original oncologist “could treat her but he could not heal her.”

All doctors have to be concerned about how they talk with patients, but oncologists connected with cancer centers should realize how important it is to speak accurately, compassionately, and with concern for the patient and their quality of life. They are supposedly the ultimate resource. We all realize they are under tremendous pressure to see more patients, and probably the most serious ones, and create miracles. They have the power to reason so they should not condemn patients, not only to death, but to deny them any hint of a quality of life until they die.

Every oncologist should realize that other specialists might know more than they do. No matter how busy they are, they should take time to search out the best answer for each and every patient. Just because their institution is outstanding and the patient places them on a pedestal, they should treat each and every patient as they would like to be treated themselves. Would they want to be denied all hope when there is a possibility of hope? And they must remember that they are treating human beings, not statistics and how many people their words actually effect.

The last chapter in my niece’s saga has not been written. It is now some three months after the original diagnosis and commencement of treatment. Three courses of the supposedly ineffective chemo has shrunk the original 7 cm x 4 cm x 3 cm tumor to less than 1 cm x 1cm x 1 cm. But as important as the result is the fact that this was accomplished with relatively no adverse side effects other than feeling tired. The patient has continued to lead a full, active life. If one of her original three physicians believe that her success is an exception, they should ask themselves how many exceptions they have condemned to death. Even if everything suddenly went wrong and she would die tomorrow, the quality of her life would have been far better fighting to live rather than waiting to die.

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