Trusting your oncologist

The following blog post was written by Tim Turnham, the executive director of the Melanoma Research Foundation. He raises a provocative question on the issue of trust: As cancer patients, do we truly believe our oncologists have our best interests at heart? I've found it's sometimes hard to believe they do, based on their cavalier manner and emotional detachment. If judged, however, on the infinitely more important basis of keeping you alive, it’s easier to trust them. I’ve learned over time that my doctors don’t need to be especially relational to be clearly on my side. If I’m not exactly “cherished” by my doctor, as Turnham puts it below, then I will gladly settle for at least being respected.

I have been around hospitals, doctors, and life-threatening illnesses for a large portion of my life, so I was recently taken aback to learn that something I had heard said over and over in those settings might actually be insulting.

People respond to serious illness in different ways.  Some people dive deep into the internet or library and read everything they can.  Others turn to family, or to a series of second opinions.  Some simply put their trust in their doctor and say, “You know what is best, just tell me what to do.”

With melanoma, though, treatment choices are particularly tough to navigate.  Two new melanoma drugs were approved in 2011.  Should you take those or go back to one of the older treatments?  If you focus on the new drugs, should you take the one that helps the immune system or the one that shuts down the tumor cells?  Even earlier stage melanoma presents similar challenges.  I know a person who has one surgeon recommending they remove a single lymph node near the recently discovered melanoma, while another surgeon wants to remove the entire lymph system connected to that part of the body.  And let’s not get started on whether or not to take interferon!

In the face of this uncertainty, the better doctors offer choices to their patients.  They carefully lay out the options, describe the potential risks and benefits of each approach, make a recommendation and then let the patient decide.  The really great doctors will also talk about treatment choices or clinical trials that are not offered in their office.  In other words, they are willing to lose the patient to another practice or institution if that is what is in the best interest of that patient.

Right after this conversation is when the question comes. The patient, or caregiver of the patient, looks the doctor in the eye and says, “Doctor, if I were your (insert relationship here: mother/sister, father/brother, son/daughter) what would you suggest I do?”

I understand the motivation behind this question.  When you feel uncertain and vulnerable, you want some inside information.  You want confidence that the counsel you’re getting is truly your best option.

I learned, though, how this seems to the doctor.  As one oncologist said to me, “When I hear that question I feel like responding, ‘Oh, you mean if I really cared if you live or die?’” 

I had never considered this side of the equation and it highlights the tough job confronting every physician who deals with melanoma.  Even more, it points to the greater challenge that every person with melanoma must face.  Each patient needs clear and promising treatment choices. They need to know that their treatment is best suited for their melanoma, to maximize length and quality of life. 

In supporting and watching the work of the research community, I think we are closer than ever to that day when we can say we’ve met the needs of people with melanoma.   Until then, I hope that every doctor will treat their patients as though they were a cherished family member.