Thursday, November 04, 2004

The Doctor Who Hated Cancer Patients

Gentle readers, may I share with you a curious phenomenon that I have observed in my practice of medical oncology? Although it sounds as hideous as it is strange, I have worked with several doctors who have such a nihilistic attitude toward the treatment of cancer that they harbor prejudice and ill will against their own patients fighting the disease. Fortunately such a breed of physician is a rara avis in the world of clinical medicine, nevertheless, it is distressing for me to have to work side-by-side with a referring doctor who is not on my side. How could any doctor not wish the return of good health to one struggling with cancer? Rephrasing the question, why would a purported healer denigrate my professional attempts at healing?

Perhaps by describing the three main species of medical misanthropes I have encountered, the reasons behind such immature behavior will become evident.

The Ignoramus: who specializes in professing no knowledge whatsoever of the proper diagnosis or treatment of cancer. By feigning ignorance, he can justify his decision to not evaluate symptoms or findings on exam that might lead one to suspect a malignancy. The Ignoramus is recognized by his utter lack of interest in learning anything new in my field; for example, if I were to announce to him that a cure for a deadly form of cancer has just been approved and is in my office, ready to be given to his patient, his response would likely be, "OK, well thanks for calling." How does this doctor advance his basic fund of knowledge if he cares little about what happens to his own patients? Is this an example of what they called "passive-aggressive behavior" back in freshman psychology?

The Pessimist: always scanning the blue skies for that tiny black cloud which will give him the pleasure of proclaiming the day is going to be ruined by rain. The Pessimist just can't accept the fact that some modern cancer treatments are costly, that they work only temporarily, that they prolong life in less than all patients, that they do not come with a guarantee of success. Hey, for crying out loud- we oncologists realize we have a long ways to go - last time I checked I didn't see that coronary artery disease was cured, either! I find I must always quote survival data to this doctor in order to receive his blessing of approval prior to my involvement in a case, as if there are no other possible benefits to treatment. There's no quicker way to disappoint The Pessimist than to call with good news, because in his melancholy world cancer is a disease that is better left untreated.

The Sadist: the less said about him, the better. I know it seems unfathomable, but there is a species of doctor who delights in the misery of his patients. He expresses this subtly - by his demeanor, his body language, his choice of words - all designed to inflict emotional harm on the patient and especially the family. He never fails to illustrate how much of the patient's suffering has been caused by the oncologist's treatment. I therefore spend much time trying to rally again those dejected and depressed by cancer, and then by their doctor. Maybe this behavior is just an example of schaudenfreude unchained, or maybe it is simple revenge for perceived past injustices. Whatever motivates him, I can state with great confidence that my success in dealing with The Sadist lies in avoiding him as much as possible!

Could it be that I'm just too sensitive, that in any medical profession we must be ready to battle wits with skeptics, worrywarts, killjoys and jerks? Fine, then let us have at it - I will gladly lift up my smiling sword of hope against the frowning Dr. Scoundrel! At least I'll know whose side the patients will be cheering for.


At 5:04 PM, Blogger Hospice Guy said...

I'm not an oncologist, so I submit one addition to your list as an outsider who spends a lot of his life looking in on the world of Oncology and working with the same “doctors” you speak of.

I would add one type to the list:

Moneylover: This doctor may well be a 75/25 mix of ignoramus and pessimist, but he exists as an easily identified species. This is the doctor who sees a referral to an Oncologist as a missed chance to make money. If the doctor is too ignorant to know what treatment options the patient has and too pessimistic to believe anything is going to work, then why would he give another doctor the opportunity to see (read: bill for) this patient. I know for a fact that the moneylover never makes hospice referrals, and can only guess that the same is true for their cancer patients who may still have a chance at a cure.

I love your writing. Keep up the good work in all areas!

At 9:34 PM, Blogger Internal Medicine Doctor said...

Great writing by the way.

I am an internist and I have seen so many patients in the final stages (small cell) who truly believe that chemotherapy is going to save them. Whatever little quality of life that they have left I prefer they keep, instead of undergoing unnecessary chemotherapy and wiping whatever is left of them away.

Unfortunately, there are times when a referral to a hospice is truly the best course of action and I haev yet to find one oncologist who would agree to this. Possibly in theory, but when it comes to staring into the patient's eyes and telling it to them like it is the oncologists I know at least, always recommend the chemo.

I believe that there is a fourth category you forgot. Those of us who really love our patients and want to see that whatever dignity they have left, stay with them until death.

At 9:38 PM, Blogger Internal Medicine Doctor said...

I posted the above link by the way to prove to you that these feelings of rejecting cancer patients are real. We as internists are quite aware when it is happening to us. We are also aware that somewhere deep inside we need to save ourselves.

Great writing by the way, love your blog

At 1:53 AM, Blogger Nurse Mia said...

Wow. How discouraging. Fortunately, I am not aware of having encountered doctors like you've described. I hope they are few and far between.

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