Elisa Quiroz [EQ]: The whole concept of giving bad news to patients, it’s a skill that you’re not really taught in medical school. When I first started trying to tell people that they have cancer, you might dance around it, and then you could even leave the room and never actually say the word cancer.
Dan Douer [DD]: So how do you do it? I mean, you’re just starting out. What, what do you do?
EQ: First, inform myself of every single detail of the patient and everything that I need to know because the first thing that a lot of patients react with is, “Could this be wrong? Are you sure? Are you double sure? Are you triple sure? We should double-check this. What does the report say specifically?” And then I try to sit down with them and eventually I’ll explain, “We did this test, and this is what it showed,” and then I pause and wait for them respond.
DD: You have to soften the shock but still be true. Yes, you have a serious disease. The treatment is difficult, but we are here for you. And when you take this approach, you begin having the trust to be able to form a relationship with another person in a physician-patient relationship. It’s compassion, it’s caring, honesty and always some hope.
EQ: I was really fortunate as a medical student in outpatient oncology, and I got to work with six different oncologists, and it was incredible because everyone has their way of doing it. Wow, his approach to talking to his patients and to making the patients feel comfortable and to, you know, gaining their trust is completely different from hers, but at the same time, their patients love them; they trust them; and they have really great relationships with them.
DD: Sometimes they have a good support; sometimes they don’t have support. That’s where your sensitivity as a physician comes in. Particularly women, there’s a specific consequence of treating these diseases. I’ll give you an example.
We had a woman; she was 41 years old. First pregnancy, she wanted to have this child, more than anything else. And in week 16, she gets acute lymphatic leukemia. No doctor in New York wanted to treat her. They said, “You have to get rid of the child.” And it’s not my decision of a physician to impose my values on patients. It’s their values, and I need to work with them. We worked out a plan with a treatment that doesn’t damage the fetus but is good enough to get some effect on the cancer. Once she gave birth, we immediately did the most aggressive treatment. If you’re asking individual accomplishments, I think that was the biggest one.
EQ: That’s the big one? (laughs)
DD: Because I was willing to go with the wish of the patient, and we found a way. It was very nice to get a picture of the baby, so it was one of the nicest things I had.
EQ: Even this early in my career, I’ve had a lot of experiences, too, where you have patients who are so grateful. They’re just a special population of patients who really need a type of physician who is going to listen to them and who’s going to really care for them. And they have life plans and families and children and all of these things going on outside of their disease.
DD: I am very much enjoying working with you. It's going to be hard, but I can reassure you I never regretted a minute.
EQ: Well thank you, Dr. Douer, and I'm excited to follow in your footsteps and hopefully someday be as accomplished as you are.