What kind of physician am I; Dr Jekyll or Mr. Hyde? Am I a barren earth, Agent Orange, burn it to the ground chemotherapist stopping at nothing to kill cancer or am I the warm-fuzzy-pink-slipper, group-hugs-all-around, sort of caregiver. Can I be both?
This eternal internal conflict of all cancer doctors was thrust back in my face this afternoon by two sequential emails. The first was the proud announcement from research powerhouse Teva Pharmaceutical Industries that their latest cancer killer Synribo (omacetaxine) was approved by the FDA to treat the chronic adult leukemia, CML. Good news for sure. However, right after that I received a brilliant Blog from medical thinker Dr. Bryan Vartabedian(Doctor V) in which he indicted doctors, like me, for our failure to connect, communicate or even examine their patients.
True, true and unrelated? I wish. Synribo is an important innovation in the fight against leukemia, but its practical impact may be negligible. After hundreds of millions of dollars spent to develop Synribo, it is only approved for use in patients that have failed two prior highly active therapies (TKIs) for CML. Then it only works in 14.3 to 18.4% of patients and for as little as 4.7 months. It will cost thousands of dollars a month. Now if you have resistant CML this is very important and exciting, but this, the second drug for the same indication approved in the last two months (Bosulif, bosutimib), will be used in less than 1/100,000 people, so its impact will likely be modest.
On the other hand if Dr V, and the teachings of Dr Abraham Verghese of Stanford Medical School who Dr. V. quotes in the Blog, are correct, then expensive, complex and limited high science medicine has replaced that most basic of medical tools, the human hand. A doctor’s touch can do so much and when we neglect such a critical and basic technology, we do our patients a great disservice. Not only can the physical exam by a doctor detect disease, but though that intimate healing ritual of personal contact and care, we heal not only body, but soul.
In 1880, the popular joke was that while there was a great difference between a good doctor and a bad doctor, there was little difference between a good doctor and no doctor at all. Then, the major therapy physicians had to offer was hope and the comfort of knowing there was someone at the bedside. It seems to me we have swung to the other side… now we offer science, which we substitute for communication, empathy, and confuse statistics for hope.
The key is to remember that patients are not numbers, experiments in a test tube or lab rats. More than any pill can offer, healing in real people includes body, mind and soul. No matter how much science we offer, we must understand patients and how that science will affect them. Patients must understand their disease and treatment, and be helped to incorporate that information so that they can set and achieve realistic personal goals. This requires listening, and empathic communication, and it requires the human touch. We need to understand how illness and treatment affect our patients, at the deepest levels, and take the time and interest to take care of every patient as the special person they truly are.
You know why they put nails in coffins, don’t you?
To keep out the oncologists.
So, I ask myself; is that me?