Being an Oncologist is a Privilege with Sober Responsibilities

Oncologists are tethered to the insatiable emotional demands of a very needy patient population. While appealing to one’s vanity, these demands can consume an idealistic oncologist who is incapable of compartmentalizing life’s priorities.

Being a physician is a privilege that involves sober responsibilities—all magnified in cancer victims. The typical patient is frightened, vulnerable, and threatened to the core. They, justifiably, expect compassion, a commitment to excellence, a seriousness of purpose, and an ethos of integrity and humanity from the cancer team in general, and especially the oncologist.¹

Being an oncologist involves a life with little room for frivolity or casualness, and dilettantish physicians who value style over substance should avoid the oncology specialties. Aspirants must realize that to perform in this arena is neither an ordinary responsibility nor a casual commitment; none in medicine should be, but with cancer, there is usually heightened passion and drama. What is euphemistically labeled “the cancer experience” can be an extraordinary test for physician and patient alike.

With an absence of an emotional commitment on the part of the oncologist and a failure to lower self-imposed protective barriers, both the patient and the physician suffer. Those considering oncology as an avenue of study should, therefore, be self-analytical in this regard: If one is unwilling to commit emotionally, a psychologically less demanding specialty should be considered.

With an absence of an emotional commitment on the part of the oncologist and a failure to lower self-imposed protective barriers, both the patient and the physician suffer. Those considering oncology as an avenue of study should, therefore, be self-analytical in this regard: If one is unwilling to commit emotionally, a psychologically less demanding specialty should be considered.

The fears of these patients range from low grade to paralytic. Whether cured or not, the cancer victim often dwells on a kaleidoscope of perceived threats—financial matters, family well being, loss of dignity, pain, deformity, dependency with loss of autonomy, being abandoned and alone, and obviously death itself—all of which can be catalyzed by an emotionally uninvolved cancer team that minimizes these deeply rooted concerns. The take home message is that needs differ from one individual to the other—some patients require more attention, others less, and if a physician does not have the flexibility to cater to this diverse emotional appetite, they should work in another specialty of medicine.

In addition to compromising their own professional fulfillment, the unwillingness of an oncologist to contribute to the emotional equation between doctor and patient often stymies the latter’s ability to develop hope. This is no small consideration, because in the practical world of cancer medicine, there is nothing psychologically more valuable for a patient than hope—but only when it is realistic and honest. Better for the physician to be noncommittal than to encourage false hope, which is deceptive, and perhaps even a betrayal of sorts.

Hope, Redefined

A physician’s balance between empathy and guidance throughout the cancer journey is the sine qua non of good leadership. Good doctor-patient relations come out of honest and forthright dialogue that is based on realism rather than paternalistic avoidance of unpleasant news. Such a relationship begets trust, which in turn begets acceptance of the inevitable as the patient is led to the conclusion of care, whether it is improvement or death. In order to accommodate this paradigm, however, hope must be redefined. Let me explain just what I mean.