Guest Column | Why doctors need to look past the stats

By Brian Carr 08/02/17 11:23pm

“You have two months left to live.” The doctor delivered the words with a steel, monotone voice without looking up from his computer. If my uncle wasn’t paying attention, he wouldn’t have realized he was just diagnosed with Stage IV throat cancer. After typing a note, the doctor told my uncle his only option was palliative care. He wished my uncle the best, and left. The appointment lasted five minutes. My uncle went home distraught, in part because of the sudden realization he didn’t have long to live, but more so because he didn’t feel he was treated as a human.

The doctor rendered his diagnosis using the five-year survival rate, often considered the gold standard for determining how long treatment will extend the life of a cancer patient. So, patients diagnosed with cancer earlier, or with a cancer that has a treatment available, usually have a higher survival rate, whereas patients diagnosed with cancer later, or with a cancer that doesn’t have a treatment available, have a lower survival rate. My uncle, diagnosed with Stage IV throat cancer, was in the latter group.

By using five-year survival rates to tell patients how long they have to live, doctors ignore one major factor: the patient’s humanity. It ignores characteristics such as a patient’s physical fitness, and more importantly, it ignores intangible aspects such as a patient’s mental status, emotional capacity and relationships.

At Penn’s School of Dental Medicine, pre-doctoral students collaborated with faculty to create a Society of Oral Oncology to take students out of the classroom and into the setting of patient-centered care. This society aims to bridge the gap between the science needed to understand cancer and the humanity necessary to treat cancer patients, moving towards preparedness in the clinical setting by teaching students the tools to deliver the highest quality care.

One seminar by Dr. Neeraj Panchal, a faculty oral maxillofacial surgeon from Penn Dental Medicine who also serves as section chief of oral and maxillofacial surgery at the Philadelphia Veteran’s Affairs Medical Center and Penn Presbyterian Medical Center, focused on dental clearance for patients receiving radiation therapy for oral cancer. The discussion focused on how patients’ emotional and mental status changed during radiation therapy, a treatment often leaving patients with scars, difficulty opening, dry mouth and inability to eat, drink or swallow. He also discussed how patients with stronger family and community support are more likely to continue their therapy than patients who live alone or are estranged. This seminar, like many others, elucidates how accounting for all dimensions of a patient’s life – not just the diagnosis – influences the quality of patient care.

Luckily, my uncle had a strong community. When he wanted to give up and accept the doctor’s prognosis, his wife encouraged him to see another oncologist. These discussions with his wife, combined with words of encouragement from his children, convinced him to try to beat cancer. The second oncologist agreed with the initial prognosis, but told my uncle that everyone responds differently to treatment. He said my uncle, a 71-year-old former linebacker from University of Wisconsin-Madison, who bikes during summer and skis during winter, was fit for his age and could begin an aggressive treatment regimen that could extend his life by six months.

Three years later, my uncle died from a metastasis to his liver. This doctor bought my uncle three years; he looked past the statistics, treating my uncle like an individual with strong family ties who could handle an intense treatment plan. During his treatment, my uncle lost sensation to his hands, his ability to bike and his hair. He never lost his smile. When he couldn’t grill at family reunions anymore, he taught his recipes to his children. He started hiking with his wife to decrease the nausea from chemotherapy. They spent a summer traveling to parks they had never before visited. To him, the decrease in quality of life was nothing compared to the memories he gained. Memories he wouldn’t have experienced if he was treated like a statistic.

In medicine, it’s important to know the etiologies and survival rates of different cancers, and the current treatments available to cancer patients. But it’s even more important to learn about the patient seeking treatment. To do this, doctors need to look up from their screens and see patients coming to them in their most vulnerable state. Patients asking for only a few more months to live. And it’s in these moments, with these patients, that doctors need to show their compassion, and deliver the highest quality care possible.

BRIAN CARR is a third-year dental student at the University of Pennsylvania School of Dental Medicine.