Surviving cancer opened window into patients' world
From the January-February ACP Observer, copyright © 2007 by the American College of Physicians.
By Paula S. Katz
When William Tierney, FACP, has to tell patients they have cancer, he does something that distinguishes him from most other physicians—he leaves out the percentages.
"When you're a patient, that's completely meaningless talk," he explained. "It's either one or zero. Up or down. Live or die. Lucky or not lucky."
He talks from personal experience. Diagnosed at age 48 in 2000 with grade IIIA non-Hodgkin's lymphoma, he's now in remission. Before his diagnosis, he split time between a part-time private practice, informatics-related research and a new role as chief of general internal medicine and geriatrics at Indiana University School of Medicine. He's since scaled back to working as a part-time hospitalist and researcher at Indiana University.
Cutting down on his work commitments is just one lesson learned, said Dr. Tierney, who is still co-editor of the Journal of General Internal Medicine. Another, despite his years of outcomes research—including a paper on quality of life in cancer patients—is recognizing how little physicians really know about what cancer patients go through.
"I thought I was attuned to how patients felt," he said. "It turned out I didn't know a thing about cancer and didn't know how it affected patients. If you haven't had it, you don't get it."
Now, because he does get it, he spends more time gaining patients' trust up front. He talks matter-of-factly about his experience—six rounds of chemotherapy, struggles to continue working, the plight of his family caregivers, his own lingering neuropathy and his simultaneous role as a caregiver to his critically ill parents.
And he offers his insight on how physicians who don't have the same kind of personal experience can overcome what he calls the "arrogance of innocence" to better meet the needs of their patients with serious illnesses.
His own battle
After experiencing chest pain for 10 weeks, Dr. Tierney finally saw his physician. "Thirty seconds into the exam she found the lump," he said. "From the feel of it, I knew it was cancer."
Not only was it hard to tell his wife that he had a life-threatening disease, he also had to overcome memories of patients who had suffered—one had died of the same disease just a month earlier—and the role reversal of being dependent on someone else.
Lisa E. Harris, M.D., a primary care general internist and nephrologist at Indiana University, diagnosed William Tierney, FACP, with lymphoma and remains his physician.
"Ultimately, I got beyond that by putting myself in the hands of the best oncologist and [telling myself to] shut up and do whatever he tells me to do," he said. "I'll either make it or won't make it and I'll find out when I get there."
Just as difficult to handle was the desire to appear normal. "As a physician-patient, I didn't feel like I could whine," he said. So during chemotherapy and the debilitating recovery year, he tried to maintain his schedule, including his role as division chief of 135 faculty and responsibility for a $70 million budget.
"It was the stupidest thing, not to give anything up," he said. "I tried to pretend I wasn't sick."
He now advises that any sick physician let others help, and delegate what isn't a top priority. "If you can do more than 50% [of what you used to do], people think you are Superman and you're going to fail," he said.
Based on his own experience as a patient, Dr. Tierney also offered the following advice for other physicians dealing with patients with serious illnesses:
Listen, observe and ask more. Take the time to ask how the patient is really doing. Note how the patient is breathing, sitting and behaving. Find out what's really bothering the patient. Early on, think, Where do I fit into the patient's story and needs? What can I satisfy and what can I not satisfy? Sometimes it's not obvious. For example, someone who ends up in the hospital because of heart failure may be most concerned about an aching back or an elderly dependent relative.
Manage pain. Dr. Tierney uses objective evidence to decide if the patient is telling the truth, then treats the pain with whatever medication it takes to satisfy the patient. "Have I been fooled a couple of times? Yep. But I'm willing to have that happen so I don't cause unnecessary suffering," he said.
Handle emotional reactions. Emotional reaction is a biochemical response that pops up at unexpected times, he said. "You just get overwhelmed at feeling out of control of your life."
Offer hope. Even patients who are definitely going to die deserve hope. "You just have to change what they're hoping for," he noted. "Focus on living well in the days that remain. That's what most of us want anyway."
Teach listening skills. Academic institutions should focus on helping their usually young and healthy clinicians to be less judgmental about patients, he said. "We're taught to be humble. We can be taught to be empathetic and listen."
"I'm a better physician ..."
Despite everything he has endured—or maybe because of it—Dr. Tierney seems to relish connecting with patients. "I'm not ashamed to admit that I've been sick. I don't use it as a lever, but where it helps patients feel more at ease with me and with the health care system, I tell them: 'I know what you're going through.'"
Medical students and housestaff listen more closely to him now, too. "I think I'm a better physician and teacher than I was before," he explained. "I think that they more readily accept that on such issues I know what I'm talking about."
And although he's personally hoping for a 40-year remission, he embraces his newest role as the hospital's "designated hitter" if anyone gets cancer. "It's a role I can fulfill-to help somebody who's suffering or going to be," he said. "I'm a physician. That's what I do."
Contributing Editor Paula S. Katz is a medical writer in Vernon Hills, Ill.
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