Dr. Wendy Harpham is a doctor of internal medicine, cancer survivor, and award-winning and best-selling author of books about cancer: Healthy Survivorship, recovery and late effects, and raising children when a parent has cancer. She is also a public speaker, patient advocate, and mother of three.
Two patients with the exact same tumor have different outcomes. Why?
Five hundred years ago, a 3-centimeter lump in one patient that looked and felt identical to that of another patient was considered the same tumor. Yet one patient did well and the other died.
With progress in science, doctors determined that tumors that look alike to the naked eye can look different under the microscope. Tumors were lumped together if they looked alike, felt the same, and had the same microscopic appearance. Yet still some patients did well while others died.
With progress in science, doctors determined that tumors that look alike under the microscope can have different surface proteins (antigens). Tumors were lumped together if they looked alike under the microscopic appearance and shared a specific array of surface antigens. Yet still some patients did well while others died.
I want to share a posting by an 80-year-old physician-turned patient. Larry Zaroff is an MD-PhD cardiac surgeon who in his later years successfully scaled the peak of Chulu West (a 22,000 foot ascent) near the Nepal-Tibet border.
My August 14th post responds to Scientists Seek to Rein in Diagnosis of Cancer, in which Tara Parker-Pope discusses the recommendations of an NCI panel that some premalignant conditions should be renamed to remove the word "cancer" or "carcinoma." The move was prompted by concerns about patients being over-diagnosed and over-treated, a problem for both Healthy Survivors and public health.
For some people, the issue is money. Increasing the use of tests and treatments helps those on the prescribing/delivering side and hurts patients and insurance companies footing the bill. They object to lobbyists and politicians having any say in determining what's best for patients.
As a Healthy Survivor, I believe the fundamental issue is captured by a Memorial Sloan Kettering oncologist, Dr. Norton: "...doctors do need to focus on better communication with patients about precancerous and cancerous conditions. He...tells patients that even though ductal carcinoma in situ may look like cancer, it will not necessarily act like cancer — just as someone who is “dressed like a criminal” is not actually a criminal until that person breaks the law.
I've devoted much of my writing life to demonstrating how substituting one word or phrase can make a world of difference to patients. Yet I still believe that changing the language cannot replace effective communication.
If dealing with the uncertainty and high stakes of a potentially life-threatening disease that requires life-altering treatment, nothing replaces the time-consuming weighing of risks and benefits for the individual and developing a personalized plan of action.
In my last post, I shared my discomfort with the idea that patients would consider following online advice that contradicted that of their physician. What does it say about the modern doctor-patient relationship?
A healing doctor-patient relationship is based on mutual trust. Patients trust that their physicians...
are expert in their field
call for advice from colleagues if dealing with a problem outside their expertise
understand the patient's situation well enough to personalize their recommendations
always have the patient's welfare as their primary directive
And physicians trust that their patients...
report symptoms and concerns honestly
let their physicians know if they don't understand what their physicians are saying
follow instructions between office visits
call for advice, if they cannot follow instructions between office visits for whatever reason
know when to call for problems
So what is it about modern medicine that would lead an intelligent, responsible person to consider following advice found online that contradicts the physician's advice?