Surgeon urges doctors to show more empathy
In the blink of an eye, life changed for Phil Gordon as doctor became patient. Now, as Susan Schwartz reports, he has delivered a clarion call to colleagues
In more than 40 years as a colorectal surgeon at Montreal’s Jewish General Hospital, Phil Gordon placed many patients on chemotherapy protocols. He considered the side effects and explained them. But now, in hindsight, he says he didn’t do a good enough job.
“Now ” is in the aftermath of a diagnosis of metastatic cancer of the pancreas he received in November 2016. In the blink of an eye, life changed. Doctor became patient. In a poignant and elegantly written article that has received considerable media attention since its publication in the current issue of the medical journal Diseases of the Colon & Rectum, Gordon, 75, documents his experience as a patient — and issues a clarion call to colleagues about the importance of empathy.
In placing people on chemotherapy protocols, “I spoke to the patient but, in retrospect, I did not do a very good job,” he writes in Chemotherapy: A Senior Surgeon’s Personal Challenge.
“This was not because I had no compassion for the patient, because I did.
“This was not because I was rushing off to the next patient, because I wasn’t. This was not because I was uncomfortable with the disease, because I wasn’t.
“This was simply because I was not in their shoes — and the only person who can understand what the side effects are is the person who experiences them. The admonition to walk a mile in someone else’s shoes means you must understand his/her experiences, challenges and thought processes. In effect, it is a reminder to practise empathy.”
Gordon, who was the first Canadian president of the American Society of Colon and Rectal Surgeons and the founding president of the Canadian Society of Colorectal Surgeons, has been recognized during a distinguished career as an academic surgeon with many awards and honours. As director of colorectal surgery at the Jewish General and at McGill University, he wrote countless peer-reviewed journal articles, research protocols and book chapters and coauthored a leading textbook on colorectal surgery.
“When I got my diagnosis, I was pretty sure that my writing days were over,” he told the Montreal Gazette. But colleagues and friends encouraged him to write about his cancer experience “from the other side of the fence.” His principal goal, he said, was to encourage doctors to familiarize themselves with the protocols they recommend and their side effects in order to explain them more completely to patients. “Words do matter,” he writes. Oncology nurses, oncology dietitians and oncology pharmacists are all invaluable sources of information, he added, and should be consulted.
To be on the receiving rather than the treating end is an adjustment, to be sure. “As a surgeon, you are in control of what you are doing,” Gordon said. “As a patient, you have lost that control completely.”
He is perhaps a better-informed patient than many others — but he is a patient nonetheless. “I am not uncomfortable in that role, although it is obviously a little strange.” Many of the doctors involved in Gordon’s treatment were once his interns and residents. Everyone treats him with respect, “and I have no complaints,” he said. “As a matter of fact, I have all kinds of compliments for them.”
A protocol combining chemotherapy and immunotherapy controlled Gordon’s cancer for several months before it stopped working. A month of a more toxic chemo regimen, “which was really brutal,” followed. Now he is on a new drug, designed for patients with cancer like his who, like him, have not responded to other drugs. Results of recent blood tests and a scan were encouraging.
By far the most significant side effect of his chemotherapy, Gordon writes, has been “an overwhelming, totally consuming, almost indescribable and debilitating ” fatigue. Other side effects — he takes various medications to help counteract them — include loss of appetite, a metallic taste in his mouth, diarrhea, anemia, numbness in his hands and feet and sensitivity to cold.
“If it is going to control my disease, I am going to put up with this crap,” he said. “The name of the game is survival. I just have to be hopeful that it will continue to work.”
Hair loss, complete in his case, doesn’t bother him much. “Do you like my hairdo? My oncologist did it!” he writes. “My wife said I looked very fashionable.”
Nothing about chemotherapy is funny “but while I was writing, I couldn’t resist,” Gordon said, “and I tried to lighten up an extraordinarily serious matter.”
Because his immunity is compromised as a result of his treatment, raw or undercooked meat, poultry, eggs and fish are off-limits. That means well-done meat, for instance, and no soft-boiled eggs. He’s fine with that, but quipped: “How can you tell a Jewish boy he can’t have lox? This is criminal.”
Gordon is philosophical. “I can’t be unrealistic. I have been at this game long enough to know this is not a good disease. On the other hand, I try to be as encouraging to myself as I can,” he said. “Right now, I’m beating the odds.”
Physicians should provide hope without being unrealistic, he writes, and also compassion. “I am hoping,” he concludes, “that the compassion I tried to show my patients over the years will be shown to me through the rest of my journey.”
As a surgeon, you are in control of what you are doing. As a patient, you have lost that control completely.