Doctors and patients

Before my Stage IV Metastatic Breast Cancer (MBC) diagnosis, I went to the doctor once a year for my well-woman visit with my OB-GYN. My husband prodded me to get a Primary Care Physician (PCP) many times over the years, but since I rarely got sick, I never saw the need. I’d head to urgent care if I needed antibiotics or was feeling particularly ill, like when I got walking pneumonia.

My how times have changed!

Now, I have a roster of fourteen (14) different doctors, some I see very regularly like my medical oncologist and palliative doctor, some I only see in a rare situation, like my infectious disease doctor. One thing I like generally about my medical oncologist is that if I have a new symptom, she is quite likely to call in a specialist to at least take a look and she stays on top of them to ensure that I get the best integrated care. She is well known in the community and since I stay within the same system of doctors usually, she has access to all of their notes and particulars. Recently, when I was scheduled to see my pulmonologist right after I saw my medical oncologist, she had me take flowers from her personal garden to him as a thank you for something that had occurred between the two of them. Giving him flowers unexpectedly at the beginning of the visit certainly set the tone!

Over the years of living with MBC, I have gotten to know the doctors I deal with regularly on a more personal level. Slivers of their humanity and the things they deal with personally come through in appointments or other encounters. When I’ve traveled to various conferences, I nearly always see my medical oncologist attending as well and I regularly trade studies and articles with several other doctors who have a more academic bent. I gather nuggets of information to be able to understand them better and, when my husband was allowed to go to visits with me, we’d compare notes.

Learning about my doctors as much as they are learning about me helps me to understand and put into context their recommendations. As a professional myself, while I worked hard to be objective, pieces of me and my bias always seeped through the cracks. For me, understanding and knowing the filter through which advice is given helps so much to know how much weight to put on recommendations. For my doctors, knowing what is important to me means they can give me better advice.

For example, my medical oncologist and nearly every other doctor knows very well that I’ve worked hard to avoid taking narcotics. This was a bit of a bone of contention between my medical oncologist and I for years because she didn’t appreciate the value of medical cannibis, which I use to manage my pain. Now she does! Earlier this year, as I was wrestling with what to do about my jaw, my medical oncologist asked me about what medication I was taking. When I told her how much oxycodone I’d been having to take to manage the jaw pain, she immediately knew how big of a deal that was. She understood the significance of how much pain medication I was having to take even though I had worked so hard not to and helped me make the best decision.

This knowledge meant that my doctor knew what I wasn’t saying, could read between the lines, and provide tailored advice/recommendations.

Recently, the shoe was on the other foot when one of my doctors who just returned to work after maternity leave was texting me about pumping and legal issues. She was attempting to structure her day around her pumping schedule for her newborn and because she knew my history, knew that I’d done that for four (4) years, she texted me to get some insight. I had offered to help if she had breastfeeding and pumping questions when she told me about being pregnant many months ago, but knowing that she remembered and trusted me to ask meant a lot. In doing so, she demonstrated to me that she sees me as a human being, not just a patient.

And then I started to wonder, is crossing the line into more personal connections a good or bad thing? Will my doctors be better able to offer suggestions and recommendations when it comes to hard choices if they aren’t able to be totally objective? It total objectivity the goal?

As a lawyer, I struggled with this at times. When I closed my office, my main focus was family law, which mainly consisted of divorces and the aftermath of a divorce. My main pro bono focus was working with children in foster care, specifically those with special needs. I dealt with so many complex emotional issues that had legal ramifications and had to work at staying objective. I often failed. I referred to the kiddos I worked with as “my” kiddos. The lines got blurry a lot and I was constantly having to take two steps back and checking myself.

I use these experiences as a gauge quite a bit. Did it help when I crossed the line from being objective to personally connecting? Most of the time, yes. When I connected with my clients personally, when there was a relationship there with give and take, I knew best what I needed to do or accomplish for them. When I knew the core values of my clients, I would be able to evaluate an offer of settlement from their perspective more easily and walk in their shoes more realistically. The downside was that I had to work not to react too much with my client when something upsetting happened — they came to me and paid me for my ability to see objectively and not be emotionally involved.

This is where I think both the lawyer/client and the doctor/patient relationship can get a bit sideways. We want the connection with other human beings, but we aren’t entering into these relationships to get a friend or a buddy. As a client or patient, what we need is the experience and expertise of the professional, but to get to the best recommendations, there has to be a connection or rapport.

As with most things, my conclusion is that there must be a balance, lines, boundaries for these relationships to be their best. Where those lines or boundaries or balance is probably is a little different for each pairing. For instance, my medical oncologist is around my mom’s age and that affects our relationship to a certain extent while the doctor I referenced above who was texting me for advice about pumping is six (6) days older than I am. Factors like age, race, gender, cultural backgrounds, etc., can change the dynamic pretty significantly.

For those of us who will be in treatment for the rest of our lives, having a team invested in our lives outside of cancer as well as willing to go above and beyond to protect our quality of life is key. It’s the subjective factor that makes all the difference.