Thursday, March 17, 2005

Where Ignorance is Bliss...

"A person is never happy except at the price of some ignorance."

-Anatole France

Those who are considering a career in medical oncology need more than intelligence, diligence and imagination to succeed. Doctors who walk through the doors of a cancer ward should bring the twin virtues of empathy and composure with them in order to care for the patients lying within. What does it mean to practice medicine with these traits? By first reviewing the definition of these words one can appreciate their importance in the field of clinical cancer care:

empathy: "an individual's objective and insightful awareness of the feelings and behavior of another person. It should be distinguished from sympathy, which is usually nonobjective and noncritical. It includes caring, which is the demonstration of an awareness of and a concern for the good of others."

composure: "steadiness of mind under stress; self-possession; a calm and tranquil state of mind."

Empathy is therefore the ability to imagine oneself as the patient and ask, "How would I feel if I had this illness?" Composure is the mental strength used to reject communicating such emotions as shock, displeasure or arrogance when exposed to beliefs or actions that conflict with one's own code of values.

Given the stresses of clinical medicine, most physicians have ample opportunity to hone these skills daily in their work. I can imagine no better way to display these two important traits than to care for patients who have delayed seeking medical attention - who have concealed the signs of cancer from the outside world. Such patients usually stupify their doctors, who cannot believe that anyone suffering from obvious symptoms would not reach out for assistance. These patients may be unable to accept the diagnosis of cancer - called denial. Some of the research published about denial suggests that it "may at times be a healthy and adaptive response to illness", allowing patients to cope more effectively. This reaction should be distinguished from avoidance, seen in patients with what I refer to as ignored cancer. Avoidance is defined as postponing the day of reckoning by concealing a tumor from family and friends. By the time an oncologist sees a patient with ignored cancer, the disease is at risk of being so advanced as to be incurable. This is called a tragedy.

There is a danger, however, in encountering such patients, namely that doctors may become so angry as to sever the bond needed between each in order to provide compassion, counseling and other humane care. It would seem natural for physicians and even family members to react with shock and derision at patients who have avoided seeking medical attention. To respond in such a manner is foolhardy and serves to only uncover weaknesses in character. We are better off to use the skills of empathy and composure, but how do doctors learn to set aside their prejudices? Must they attend a course on learning coping skills? Is there a secret to caring for patients who have secrets?

Hey, what do I know? I'm just a country doctor, not a psychiatrist!

This doesn't mean I don't have an opinion, of course. Let me give an analogy about meeting patients who have delayed their diagnosis of cancer:

A patient who is found to have an ignored cancer is like an automobile accident. Shock and disbelief fill the mind. Anger is directed at others for the predicament. Emotions run high. Fingers of blame are pointed. Pain and suffering occur. People are inconvenienced. Sometimes life is never the same.

No matter who is to blame for the calamity though, somebody has to show up and clean up the mess, triage the injured and get traffic flowing again. This is what oncologists do. We are the traffic cops and tow truck operators of the cancer universe. We get people moving again down the road to good health whether they come to see us early or late in their illness, without holding a grudge against them.

Empathy and composure are the keys to aiding an accident. Doctors who embrace these traits will not let petty emotions distract them from finding the healing that their patients also seek, even those patients who wait until the last minute to disclose their desperate need.


At 10:10 AM, Anonymous Anonymous said...

...tis' folly to be wise.
-Thomas Gray

(thought it would be polite to finish this quotation)

At 7:41 AM, Anonymous firefall said...

All I can say is thank you, for being able to reach past anger & derision to empathy - speaking as one who went through deep avoidance/terror

At 2:05 PM, Anonymous R Wiseman said...

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At 5:00 PM, Blogger Dreaming again said...

My husband doesn't have cancer, but he does have, in effect, a terminal condition. He is doing nothing to postpone or decrease the chances of the terminability (is that a word?). He has scoliosis from having had polio at the age of 3. (picture of his scoliosis curve here:

He won't go on oxygen (even though his breathing is at best 43% of normal on a good day). He won't take physical therapy to increase the rib cage movement. He won't take the muscle relaxants and pain killers that could improve his quality of life. He refused the life saving surgery in his 20's that could have prevented the condition he's now going through.

He refuses the stress test & other cardiac testing to see the severity of his atrial fibulation & mitrovalve prolapse.

I ... am angry. How the doctor's can look him in the eye and not say "MAN! TAKE CARE OF YOURSELF!" is beyond me.

I can understand your frustration in seeing undiagnosed cancer. I don't understand burying your head in the sand. I admire your ability to reach beyond and still remain compassionate ...

At 1:53 PM, Blogger Gary said...

One thing a human has is the knowledge that he is going to die. The manner of his death can be of his own choosing or that of others.
My dermatologist checks my skin every 6 months for cancer. I spend the time because skin cancer is curable.
No doctor examines my lungs because lung cancer is not.

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