At what point in a physician’s career does the transition occur – the transition from considering his participation in patient care as a remarkable privilege to a quotidian nuisance?
Out of the plethora of specialties that exist in the medical field, oncology must rank among those that require the most gentle and attentive of bedside manners. These doctors are, after all, giving one of the scariest diagnoses.
With a disheartening prognosis in hand, the experience becomes even more intimidating with treatment options that can often feel to be a greater adversary than the disease itself. The word “cancer” immediately elicits images of sickly, bald-headed patients, nauseated and feeble as drugs systemically kill both their healthy and their diseased cells.
In acknowledging the mere strength of the word – how it commands respect and evokes fear when simply uttered – this fact alone should necessitate that, at the very least, the physician possess the ability to deliver such a life-altering diagnosis tactfully, with great sensitivity and care. Yet, the very antithesis of this occurs daily.
In a recent and most atrocious offense to this basic standard, the diagnosis was delivered in the very callous and thoughtless presentation of a small, yellow Post-it note.
Abnormal symptoms and suspicious blood work landed Patient X at a cancer center. There he sat with his wife and daughter, anxiously waiting to speak with the physician, whom he hoped could create a more cohesive picture with the seemly disparate and unusual clinical puzzle pieces. With each tick of the clock, both he and his family grew more uneasy, restless and concerned.
Three hours passed before the secretary finally appeared. They could leave, she said. They would be contacted in a week with information about an appointment.
Patient X’s wife and daughter, both health care professionals, were perplexed. Clinical findings showed his blood count was abnormally low, his job required extensive travel to infectious disease centers and they were worried about the safety of this combination. Exasperated with the onslaught of questions, the secretary exited the waiting room, assumed to be returning with the doctor.
Instead, she returned with a Post-it note. Scribbled on the square, yellow paper were the letters CLL. Chronic lymphoid leukemia. They received a diagnosis of cancer by the means, and equivalent thoughtfulness and effort, with which one writes a grocery list – an abbreviated one at that.
A correct diagnosis of Stage IV Mantle Cell Lymphoma would come the next day from a different physician, along with the fact that, left untreated, his cancer would have killed him in less than two weeks.
If left in the callous hands of Dr. Post-it note, one of the last weeks of Patient X’s life would have been spent misdiagnosed, waiting for an appointment.
The importance of bedside manner has been taught by medical scholars for 1,500 years. Is it technology that has severed the once happy marriage of science and art that comprised medicine at its core?
The X-ray, CT and MRI all allow the physician to bypass the physicality that once grounded the patient exam. No need to palpate the abdomen with your hands when the scan can provide a clear, internal view.
Perhaps it is insurance companies dictating the time spent with each patient, or the slashing of reimbursement that creates haste in the exam room.
Whatever the answer may be, it is the next generation of physicians, like myself, that has the potential to reconcile this disconnect between science and healing, giving patients care founded on humility and compassion as much as reason and evidence.
Until then, patients must advocate on behalf of themselves – ask questions, gain second opinions and, most importantly, refuse the care of any physician who diagnoses by proxy of a Post-it note.
Brienne Ryan, of Amherst, will be a first-year medical student (class of 2019) at the University at Buffalo School of Medicine and Biomedical Sciences. She has a bachelor’s degree in biology from Syracuse University and a master’s degree in biomedical sciences from Roswell Park Cancer Institute.