In an essay entitled Complications:
Surgeon’s Notes on an Imperfect Science, Atul Gawande, surgeon, writer and
professor at Harvard Medical School wrote: “Just as there is an art to being a
doctor, there is an art to being a patient. You must choose wisely when to
submit and when to assert yourself.”
This advice is especially important if
you have just been diagnosed with prostate cancer. Because prostate cancer is
so common, and in most cases so slow growing, that to submit to any form of
radical treatment could be a huge mistake, and hugely detrimental to your
quality of life. Yet most doctors you consult will advocate some form of
radical treatment. It’s what they know, what they do. And it goes against the
grain for both doctors and patients alike not to treat cancer.
But prostate cancer is unique among
cancers because the mortality rate is so low. Autopsies reveal that more than
50% of older men have the disease, live with it, and die from something
else—sometimes without ever knowing they had a life threatening condition.
Furthermore, the life expectancy of men with recurrent prostate cancer
stretches out well past a decade. And yet the radical prostatectomy, one of the
most complex and challenging surgeries because the prostate is located in
absolutely the wrong place for a simple surgical solution, is still the most
widely recommended treatment option. It is also the most unnecessary, and the
one most likely to leave you incontinent and/or impotent.
My own experience with urologists has
not been a happy one. Twenty years ago, a doctor who wanted nothing but patient
compliance, told me that if I did not agree to immediate surgery I would be
dead in two years. His recommendation and prognosis were not only wrong, but in
my opinion violated the ancient medical precept incorporated in the Hippocratic
Oath: “First do no harm.” Fortunately I
was not the kind of patient to be easily intimidated.
A significant part of any doctor’s job
is to create a relationship based on trust, confidence and hope. And as
patients, our job is to put ourselves in charge of our recovery. It is
our job to do the research, and give ourselves permission to say “No” if we
feel the recommended treatment—for what ever reason, or simply instinct— is not
right for us. My decision not to be
intimidated by what, in effect, was a death threat, but to monitor the cancer
and take the time to educate myself, has given me many years of quality time
with my wife that almost certainly would have been lost or diminished if I had
committed to immediate surgery.
Doctors have busy lives. They believe
in what they do. But often they tend to treat the disease and not the patient.
Traditionally we’re encouraged to go along with whatever they recommend, and
asking questions, or refusing to follow advice is unpopular. But this
passive attitude does not serve us well. The feisty, “difficult,” assertive
patient, the one who challenges the doctor, is the one who has the best
outcome.
1 comment:
Hi Ralph,
Thanks so much to you and Dr. Scholz for your book and this blog. Both kept me from becoming one more surgical case and after 3 years I am still on active surveillance. Thankfully my greatest fear has always been over-treatment, not PCa. Your book is largely responsible for my current happy state of health.
Your comments are spot on:
"A significant part of any doctor’s job is to create a relationship based on trust, confidence and hope. And as patients, our job is to put ourselves in charge of our recovery. It is our job to do the research, and give ourselves permission to say “No” if we feel the recommended treatment—for what ever reason, or simply instinct— is not right for us."
I also wanted to give a shout out to Richard Lam, MD, Dr. Sholz's partner who exhibits all the traits that one would hope for in their caregiver. I feel mighty lucky to have found him -- despite a trek from the east coast to see him from time to time. Well worth the plane fare.
Thanks again and keep up the good work.
Peter Hollis
Hillsborough, NC
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