I count myself very lucky that, as a Cancer World journalist, I get to meet some of the top names in cancer treatment and research across Europe. There have been some fascinating recurring themes from my interviewees over the years: a seven-day-a-week commitment to work; the lasting influence of fellowships to the United States early in their careers; their faith in the younger generation of doctors and their ability to inspire their elders.
But there is one thing that none of these inspiring people ever say, and it has always puzzled me. While most will talk about the doctor-patient relationship and the fundamental importance of patient-centred care, none talk about themselves as patients.
Yes, it’s true that when I ask doctors or nurses about their own experience of cancer they will often tell me about personal or family episodes of illness. But for all our plentiful discussions about the importance of empathy and the intensity of the illness experience, health professionals still talk about “patients” as if they were a different category of person from a doctor or a nurse.
An ingrained them-and-us attitude
When entering into a conversation about, say, patient-driven research, I keep on half-expecting an interviewee to voluntarily say “Well, of course, I’m a patient too” and to talk about how their own experience has helped inform their approach. But they never do: even though 99% of those researching or treating cancer will themselves have consulted a doctor about some ailment at some stage of their lives.
Long-established patterns of working, traditional hierarchies, medical training and a perceived need for cool detachment seem to have ingrained the them-and-us attitude into health and professional systems. It almost seems as if many health professionals don’t dare associate themselves with those on the receiving end of things: they see it as necessary to be aloof, separate from the experience of illness.
Detachment clearly has its place. But it does seem odd that even enlightened health professionals seem to fear there is something unprofessional about openly consulting with feelings about what it’s actually like to be ill, worried and confused.
An odd Spartacus fantasy
Perhaps I’m wrong. It’s certainly true that some doctors have spoken very eloquently about how illness has made them reconsider their work. Oncologist Fazlur Rahman wrote brilliantly in The Oncologist (reprinted in Cancer World in March) about his experiences after a traumatic ankle injury, and how unfeeling doctors transformed his attitude to empathy in medicine. And before his death at the age of 37 in March, neurosurgeon Paul Kalanithi blogged wonderfully about how he handled waiting to die following a diagnosis of metastatic lung cancer.
But it seems odd to me that associating with the patient side often comes as a revelation. I suppose what I’ve been expecting all these years is a more everyday acknowledgement that, actually, the dividing line between health professionals and patients is an artificial one. I have an odd fantasy of a plenary session at an ECCO conference where, one after another, doctors stand up in the auditorium and declare, Spartacus-like, “I am a patient”.