Archives of The Cheerful Oncologist, Volume 2

When patients on occasion express dissatisfaction with one of their doctors I listen carefully to the story, striking an avuncular pose worthy of Marcus Welby while silently judging the severity of the transgression being relayed. If the offense turns out to be a mere velleity, or if what we have here is a failure to communicate I do my best to help them “put it all in perspective”, which is just a cheap euphemism for “Look, can we move on here to more important things like how are we going to keep you alive long enough to attend your daughter’s wedding next spring?”

Sometimes though, when patients are truly unhappy with their doctor I will remind them that medicine is more than an art and a science - it is also a consumer product, and its customers are free to change doctors with as much impunity as changing department stores. This makes me look like a real do-I-play-one-on-television-yes-I-do caring guy, and sometimes patients will change physicians. Hey - that’s their right, right?

Right - except when I’m the one being fired. Heaven forbid I would ever find myself on television, sobbing into the silky suit jacket of Dr. Phil while revealing my inability to accept rejection, but perhaps I can confess to you the gentle reader that it drives me nuts when I get fired. I tend to take it personally, and as we all know doctors need to maintain a certain veneer of objectivity in order provide effective care in times of stress, defined as anytime patients aren’t doing well, and if they were doing well they wouldn’t be in your office anyway now would they?

Right. My latest entry into the Chronicles of the Cashiered occurred when I met a hospitalized patient who had been diagnosed with cancer (a recurring theme in my career). I counseled him about his diagnosis, the treatment options available, the course of action I recommended and the overall goal of therapy. I recall he listened rather impassively, but it was not until he saw me next week in the office that I realized he was seething with anger. Like a flag in a hailstorm I had to take a pummeling from him as he barked out his displeasure with me. After muttering Kyrie Eleison (sotto voce of course) for the fourth time I rallied my spirit and asked him what was it I did that caused such consternation. He looked at me like a country parson who just heard his prize Sunday school teacher let loose an unflattering saloon epithet and uttered thusly:

“You told me too much.”

I struggled to maintain composure while digesting this chunk of criticism. If I understood correctly, my sin was not one of omission, where I failed to take the time to thoughtfully explain this serious illness to my patient, but one of comission. I told him too much about his disease. What on earth did he mean? Years of experience wandering in the realm of the upset patient allowed me to come up with a hypothesis: he was trying to tell me that when we met he was not pyschologically ready to accept his diagnosis and all my blabbering about “cancer” did nothing but slice into him with the force of a thousand knives. Such a gruesome attack however can be repelled with a well-documented defense, used by all the popular kings when confronted with a morsel of rancid news, viz. kill the messenger.

Well, I officially considered myself prostrate on the regal carpet in front of a throne, an arrow triumphantly protruding from between the shoulder blades. Where do I go from here? As I mentioned I can’t stand being fired by patients - one time a patient fired me because I was not wearing any socks. Hey, it was Saturday afternoon in July! Just once why can’t the doc with the overheated tootsies keep cool and look fashionably preppy on his weekend rounds? Is all this sacking of physicians just an example of displacement, for Pete’s sake?

As it turns out, this story has a happy ending. This patient returned to my care and is now on appropriate treatment. Our relationship has not only improved, it has become cordial and all efforts are being made to help him strangle foul, cowardly cancer, that slaps one in the face then runs and hides under the bed and begs for mercy.

Mercy? Mercy? As the Immortal Bard said, “Nothing emboldens sin so much as mercy.” My patient is fighting for his life and as far as his cancer is concerned, it can rest assured that it will be greeted with a hail of bullets when the door is kicked in by the special forces platoon.

Oh, and as to how I convinced him to not fire me? I focused all my energy on getting him to focus all his energy not on the despair of today but on his future, which he finally realized was less than rosy unless he got rid of his tumor. This technique is called reorientation - works like a charm, too - when it works. In the meantime I must work on my psychological skills. I know just what to do, too. The next time I have to be the bearer of bad news I will remember to add the following coda when my unfortunate pronouncement “You’ve got cancer” is met with a critical cri de coeur:

“I can help.”