I cannot imagine anything worse than being an Oncologist. All that bad news to break, bearing witness to such heartache whilst knowing that the medicine you give to heal can often do such harm and sometimes will not work at all. And it must be so hard to keep up: there are more and more patients coming through the door with a complex set of conditions; immunotherapy and genomics are transforming our understanding of the disease and everyday it seems there is a new research paper that you simply must read, (once you have finished reading the latest national guidance on what you are and are not allowed to prescribe). And in the midst of this whirlwind of knowledge, there are raw-faced patients and families queuing up outside your door waiting for you to tell them what is going to happen next. On every level – emotional, scientific, managerially – your job seems impossibly complex.
Except it’s not. Dear doctor, I want you to take a step back and remember that despite all the noise and activity that surrounds you, at its heart, your job is actually very, very simple. Your job is to make patients feel better. I don’t mean this in the curative sense. Going back to the roots of the word ‘disease’, it comes from old French and then Middle English and means ‘lack of ease’. When we sit in your room, yes we want ‘the results’ of that scan, those blood tests, but that is really a means to an end. Whatever that scan says, we want you to relieve our anxiety and dis-ease. In these dark days, we want you – we need you – to make us feel better.
I am writing this because my partner is fortunate enough to be cared for by an excellent team at a leading teaching hospital. There is no doubting their intellectual abilities or devotion to their patients. However, within a team there are different personalities and it is clear that some doctors seem to think it is their duty to tell us just how bad things are and how awful they are about to get. Perhaps twenty years ago, this would have been a terrible but necessary burden for the doctor alone to carry. But in 2017 we have the internet, so believe me, we know exactly how bad things are. The statistics could not be more bleak and there is no room for ambiguity or denial. What we need is for you to make us feel better, despite everything that is going on.
Every consultation with you is dissected and discussed: did you notice how he never smiled, the way he looked at you, not me? The Macmillan nurse was there (a bad sign) and he didn’t show us the scan (even worse). Everything is taken apart and discussed, weighing your words and the heavier silences between them, over and over again. Therefore, dear doctor, I am not asking you to ‘improve your communication skills’, but to be sensitive to what you are transmitting. Like a super hero, your every move is so powerful to us mere mortals.
This might sound like yet another complex request on your time but again, it is actually very simple. Before you call us into your room, ask yourself what is the key message that you want us to take home? Above all, how do you want to make us feel? Once you have decided that, be careful not to bury any positive messages in the debris of caveats and statistical probabilities. We can get that from the internet. What we want from you – the flesh and blood doctor – is a flesh and blood human being. What we need from you is to help us feel better. There is no such thing as ‘false hope’. Hope is a speculation on the future, just as misery is. But the anticipation of loss, of grief and pain has absolutely no value or purpose other than detracting from the life we have left to live.
So in conclusion, dear doctor, my key message that I want you to take home today is that it takes fourteen years to train as a consultant; a life time to develop into a fully-fledged human being and sometimes, just ten minutes to break our hearts.