My husband Mike recently found an online interview with Dr. Shane Dormady , an oncologist with El Camino Hospital in Mountain View, California. One statement from the interview especially caught my attention: ”Is it a 95 percent chance they will die, or a 5 percent chance they will survive? We like to look at that 5 percent–because 5 percent is not zero.”
Dr. Dormady generously took time out of his busy schedule to answer a few questions:
Do you agree a doctor’s words hold power? If so, why?
A physician’s words carry such power that it’s staggering. In particular, I have found that patients who are in their 60s-80s grew up in an era where the perception was that doctors were considered infallible and that their every word was felt to be the gospel truth. Of course, this is not the case. On day 1 of medical school, the Latin phrase “prima non nocere” is introduced to fledgling doctors and this quote is famously translated as “first, do no harm.” As an oncologist, even if you don’t believe you can actively treat, reverse or cure an individual’s cancer, you can still help them. In other words, don’t add insult to injury and take their hope away as well.
Now, this doesn’t mean mislead or misinform your patients. It just means focus on the positive!! I even tell patients that aren’t doing well and need hospice support, “We are not giving up! The cancer still wants to make you sick, nauseous, short of breath and have pain. We are still going to actively treat you to prevent ALL of these symptoms!” I make a point to visit all of my hospice patients at home so they know that I am still there with them fighting and this gives most patients great comfort.
I am also stunned that an alarming number of oncologists use their first meeting with a patient and their family to be as absolutely negative as possible, regurgitating tables of statistics that indicate how poorly someone will do and how they have no hope for cure. I use my first meeting to rally the patient’s fighting spirit and emphasize that NO doctor has a crystal ball and no patient has an expiration date tattooed on the bottom of their foot.
What do you tell a stage IV patient when they ask about their prognosis?
I tell them that there is a rather small chance that we will be able to cure their disease with chemotherapy alone but immediately emphasize that “a rather small chance” is not “no chance.” I then give them numerous examples of patients I’ve treated with stage IV disease who have responded so well to therapy that their cancers have entered “complete remission” for months, years and sometimes decades. I reassure them that I am one of the most aggressive oncologists in existence and that we will treat, irradiate, “cherry pick” and tirelessly battle their disease for as long as we both think its reasonable.
I tell patients that our goal is to turn their stage IV cancer into something like diabetes or high blood pressure. In other words, we are going to turn the cancer into a long-term problem … as long as they get their treatment, the disease will stay controlled. I then emphasize that if standard treatments buy us one month, six months or five years, we will focus that entire time on living their lives to the fullest and hoping that the time we buy allows for the development of new therapies or new clinical trials that will help us to further “reset the clock” on their cancer.
Could you provide a success story? Since it’s Breast Cancer Awareness Month, perhaps a breast cancer patient?
I refer to my special patients who beat the odds as “walking miracles.” One of my most memorable breast cancer patients was pregnant at the time of their diagnosis. She was close to full-term and delivered her baby just seven days after her diagnosis. I could feel a large breast mass, as well as large lymph nodes under her right arm. I was happy the baby was delivered so that I could rush to complete her staging scans. To all of our dismay, a big bone metastasis was seen in her thoracic spine.
I treated her aggressively with chemotherapy, she underwent surgery and, after healing from surgery, I did not listen to the “experts” who told me that this young mother had a “terminal prognosis.” I refused to accept that. I told the patient that we would move forward with a plan to use Cyberknife radiation to eliminate the metastasis in her spine. I’m happy to report that she is now walking her five-year-old daughter to kindergarten each morning, and her PET scan last week was completely clear!!
In my book, I identified some common attributes of the people who beat the odds, such as perseverance, positive attitude, giving back to others, being proactive, etc. Have you noticed any commonalities in the patients you treat who are the “five percenters?”
In addition to the factors you mention, I find patients with strong, loving families always do well and have a much greater chance of entering the “5% club.” I also find that patients who rely heavily on their faith and religion also do well. The latter group of patients don’t get too anxious or caught up in the “what ifs” of their treatment and peacefully just say, “I trust my doctor, I love my family, I will do what is recommended and then the rest is in God’s hands.” These patients seem to unload a great deal of fear, worry and anxiety by doing this.
Somewhat comically, it is also the patients who have no insight into their disease or truly don’t care who always seem to do well. One patient would continuously make me laugh. While getting chemotherapy for the worst kind of lymphoma imaginable, I would always hear him talking to his family members on the phone saying, “I don’t know! It’s leukemia or something; I just want to get my season tickets for the 49ers next week.” He would never go into more detail, and I’m not sure he could have, since he never listened to a word I said … but he did show up for his treatments like clockwork. Of course he is doing great in complete remission four years later.
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