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A good doctor?

April 24, 2008

back after a long layoff:  I have decided that if I post only infrequently then I won’t get too many readers so I can be more than usually self-indulgent

For some reason I went through a period of what we used to call at medical school an ILA or “involuntary life assessment” today.  As part of this I was asking myself if I am a good doctor.  Certainly by most objective criteria (patient and colleague feedback, publications, grants etc) I do well.

On the other hand I know that I am a much better doctor at the beginning of someone’s cancer journey than I am at the end of life.  I am not alone in this, certainly.  But I and many other cancer specialists I suspect struggle with the transition from giving hope when there was little (at which I am good!), and knowing how or whether to maintain hope when there is none.  All of my patients have thought about dying, each in their own way, and many of them are happy to talk about it.  Some are not.  very few will introduce the subject. How does one know?  In reality there are a myriad of verbal and non-verbal cues.  What should I say?  Honesty of course-they deserve that.  But do people want or need to be told the bare facts-“You will die within the next few days,weeks,hours”.  At such a time what people need is a friend, not a doctor.

A famous professor at the Royal Marsden said to me words to the effect that an oncologist should be a guide on the journey, a strong ally in the fight and a friend in death.  I fear I am a very good guide, an excellent ally but perhaps a poor friend.

No amount of communication skills courses can give me that.  I hope experience will

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