Dual Perspective

Each month I receive an online newsletter from “Cancer.Net”.  The newsletter provides approved information to help patients and families make informed healthcare decisions. A recent issue titled “What is Tumor Board?” catapulted me back in time.

It was in 2002 that Dr. Letha Mills, medical director of Southwestern Vermont Regional Cancer Center, introduced me—a medical humanist—to the members of Tumor Board. I was invited to a weekly meeting of physicians who review diagnostic findings and offer suggestions for cancer treatment. Their facial expressions begged the question—what exactly is a medical humanist?

Dr. Mills was quick to note that I asked patients about their understanding of diagnosis, prognosis, treatment plan and how they were coping with illness. My role was to document the patient’s perspective—in their own words—for the cancer care team, providing a tool to identify issues and concerns that may not have been discussed at the office visit. From the look on their faces the physicians still seemed a bit puzzled but it was time to review cases.

I watch as the radiologist slips the image of the patient’s breast from 6 months ago into the left side of the view box. He then places her x-ray, taken yesterday, next to the first image. The patient had discovered a lump in the same breast.

Using a laser pointer, he takes us through his “read” from 6 months ago, which “shows no sign of abnormality.”

I imagine she breathed a sigh of relief, as did I, after my last mammogram.

But her x-ray today highlights a 3 centimeter mass.

“How can that be?” I asked

“It’s an incidental finding,” the radiologist said.

I try to understand his choice of the word “incidental,” which is defined as an unpredictable occurrence. Is he saying that all women by mere fact of gender are at risk for breast cancer?

The radiologist turns to the side-by-side mammograms to reassure me, and probably him, that nothing was missed.

One of the surgeons responds to my question. “Some cancers can take up to ten years to develop into a detectable mass.” Adding, “85% of women with breast cancer have no family history of the disease.”

I would not find comfort in knowing that unbeknownst to me something monstrous was happening inside my body.

“What do I tell her?” He asks me, noting again that 85% of women with breast cancer have no family history.”

“Tell her that you don’t know. What you know is that when this happens we have to confront the limitations of science and that the result can sometimes inflict both physical and emotional suffering. It would be a mistake for me to try to explain what can’t be easily explained.”

“Ah,” he says. “So you’re telling me to let the patient know that I don’t have the answer.”

“Yes, I think it can help to recognize the experience through one another’s eyes. A duel perspective can humanize the doctor-patient relationship.”

“Ah,” he says again. For a moment it appears that he’s lost in thought. Perhaps, he’s imagining himself having this conversation with his patient.