Barton A Kamen, MD, PhD - Reflections on patient care when cure is not possible
It is both embarrassing and frustrating for me as a physician to see the recent flurry of reports in the lay press about end of life care for patients with cancer. This is likely the result of the American Society of Clinical Oncology providing material to help oncologists talk with patients about terminal disease.
Medicine is a highly specialized service, an interaction of physician and patient, not a “health care provider” and a “covered life.” Medicine is an art and science. I remind students and residents that they will take care of people afflicted with a disease, not a disease. To have this topic on the front page of newspapers means we have not been practicing the art of medicine well! There are multiple causes, some “sound bytes” could include: “Medicine has become a business” or “Time is money.” It is easier emotionally and more profitable economically to write a prescription for chemotherapy, even within the last few weeks of life then it is to spend time talking with the patient and/or family. It is more profitable and likely safer in our litigious society to order tests. Is this under the pretense of the doctor not wanting to remove the last hope of cure, a miracle, for the patient or for that matter, him or herself?
Palliative from the Latin root means to cover up, cloak. In the broadest sense all treatment is palliative, although it is generally defined in the context of care that will not result in a cure, but will increase the quality of life. For 35 years I have cared for children and for nearly all that time, specialized in those with cancer, this included making house calls. Sometimes the best treatment for a patient may not include anti-tumor therapy, but only compassionate care for emotional issues and pain.
If your doctor does not give you the time you need, does not talk to you, show you a scan result, discuss options for care, including clinical trials or only palliative care, then find another doctor! It is time to recognize and compensate the cognitive function and time that physicians spend with patient. This will increase quality of life, likely increase life and in the current times, even be more economical for society.