Cancer is a personal journey. We often see and hear from patients, families, and their caregivers about how this disease changes their lives. However, what is often missing is a physician’s view of the role that the physician plays in the battle against cancer.
At the 2020 virtual conference of the Cholangiocarcinoma Foundation, Mairéad McNamara, MBBCh, PhD, MRCPUK, Senior Lecturer and Honorary Consultant in Medical Oncology, the Christie NHS Foundation Trust, Manchester, England, related her personal odyssey in the treatment of patients with cancer.
When oncologists approach the treatment of a new patient, they rely on the best evidence available, such as the guidelines of the National Comprehensive Cancer Network or other national organizations.
However, as Dr McNamara noted, “What is clear is that there are many shades of gray,” especially when the patient’s clinical picture does not fit neatly into available guidelines, and no good evidence is available for alternate therapies.
Dr McNamara equated the task of trying to develop a treatment plan for such patients to putting together a jigsaw puzzle. The individual pieces, such as the patient’s clinical history, bloodwork results, imaging studies, and biopsy results, need to be combined with the patient’s performance status, comorbidities, and any current medications, as well as the patient’s wishes and expectations.
In addition to the clinical aspects of providing care for patients with cancer, Dr McNamara emphasized that empathy and compassion in healthcare play vital roles in the patient experience, and these are key components of the physician–patient relationship.
Physicians expressing empathy is a highly effective and powerful tool, Dr McNamara said, which builds patient trust, calms anxiety, and improves health outcomes. She pointed out that persistent exposure to death and professional detachment from the patient experience very often lead many patients, families, and caregivers to see physicians as cold or uncaring. But she added that physicians are not immune to the grief and stress that patients and their caregivers experience. And like their patients, physicians manage their grief and stress in unique ways.
In developing her presentation, Dr McNamara said that her research led her to several published articles on physicians’ personal journeys in confronting grief.
One book in particular that was helpful in understanding how physicians cope with death was by James W. Forsythe, MD, HMD, author of About Death from a Cancer Doctor’s Perspective. The common themes that ran through Dr Forsythe’s book were the same themes that patients struggle with, including anger, fear, denial, and frustration. Furthermore, one of the most often asked questions by physicians is, “How can I cope, if at all?”
What is the reality for physicians when one of their patients dies? An article discussing physicians’ feelings about their patients’ death explored the emotional experiences of physicians who care for dying patients.1 Dr McNamara noted that physicians recall 3 categories of patient death: the “good death,” the “overtreated death,” and, the emotionally most powerful for physicians, the “shocking or unexpected death,” which leaves many questions unanswered for physicians.
Dr McNamara closed her remarks by reminding the attendees that it is important to remember that although physicians often need to give patients and their families bad news, “at the end of the day, people will not remember what you said or did; they will remember how you made them feel.”
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