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Cancer Care Chronicles
July 22, 2021

The Cancer Consultation: A Patient Artfully Tutors an Oncologist

Author Affiliations
  • 1DeCesaris Cancer Institute, Anne Arundel Medical Center, Annapolis, Maryland
JAMA Oncol. 2021;7(9):1287-1288. doi:10.1001/jamaoncol.2021.2523

This happened a while ago when I knew less. But I have been too embarrassed to tell anyone about it until now.

A man came to the oncology clinic for a consultation 3 weeks after an urgent colon resection for colon cancer. He looked elderly, with just a hatband rim of hair. His hands were those of a laborer. Indeed, he had worked to build many of my city’s buildings, including my hospital when it was being rebuilt.

He listened carefully and respectfully to everything I explained. Intermittently he would nod, and from behind a small smile utter, “hmmm,” “I see,” “yes, correct,” and “right.” These are excerpts from my assessment and plan for this patient:

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3 Comments for this article
Alton Thomson, MD | None
Often times our patients will teach us far more than medical school and training ever did. When we find that bit of knowledge let us grasp it and hold it in our minds forever.
Patient centric we do always not seem to be…
Dilipsinh Solanki |
I have read every single one of the “ Art of Oncology” essays in the JCO. They invariably told me and taught me what seems to be always missing from our interactions with cancer patients and from our education about what oncology should be. JAMA Oncology has these off and on. Of many I have read in both locations , this is the most touching and sincere.

A man who could only manage to do physical labor to make a living in America was not only a polite man but a lover and admirer of poetry
and history. It has been my experience that my young partners know when their patient is an executive or a Professor or a professional but rarely an average patient’s occupation or their interests or hobbies.

I remember a discussion a few years ago, at high levels, decrying that “ young doctors don’t know how to talk to patients , esp cancer patients.” What was under discussion was the sense that there was “ coldness, dryness” about the communications. In fact, ASCO felt compelled to create guidelines about how to talk to cancer patients. The first item on it was “ Sit down”. Such are the state of affairs. We come up with terms like “ patient centric” and “ patient reported outcomes” ! Well, who should be at the center and who else but the patient should be reporting how he/ she feels about his or her condition and treatments?

Wonderfully written and presented.

( I am 78 and was in Oncology practice for 50 years.)
Learning from Patients
Daniel Krell, MD | Retired PCP
Thank you for sharing such a valuable and instructive moment in your practice. This is how doctors get seasoned. After training, we have the mechanics of medicine — we have the lyrics, but not the melodies. We likely (should have) had presentations about and experiences that brought our attention to the humanity of our patients. But in training this, too often, gets shouldered aside by crammed schedules, the drive to learn as much technical information as possible before going out into the world, the need to teach and mentor those following us in the process, and the need to meet the expectations of our universes of mentors, peers, accreditation and certification organizations, etc. Oh, and we also have to maintain our personal lives.

Then, you are out in your practice. You apply the best science you have and you have encounters that teach you, and leave you shaking your head at how you missed the forest for the trees, with some patients. You learn the melodies of your patients and their families; you recognize what a privilege it is to be welcomed into their lives; and you recognize that you are part of their living novels.

In the past decade, we have encountered a strengthening headwind, in which we are judged by our responses to identifiable conditions; judgment that does not recognize the melodies of our patients’ lives. Over the years, I had numerous patients who chose to not engage in recommended care for identified conditions, and would have been dinged for not doing that recommended care; luckily, I was spared this monitoring. In spite of this increasing world of algorithms, protocols, and checking academically determined boxes, we must not forget the people into whose lives we’ve been invited.