I have been thinking lately about trust, and about obedience. About the importance of having confidence in your treatment team, and the difference between confidence and unquestioning compliance.
I know a long-time advocate, a Stage IV survivor, who is passionate about keeping abreast of the latest treatment options. She has learned that the standards have changed around when to do colon resection.
A little background is in order. When you hear that you have cancer the first thing you want to do is get that horrible thing removed from your body. And typically that is what people did with colon cancer. The first thing that happens is abdominal surgery to remove the primary tumor. In recent years, though, that approach has been called into question, particularly for patients who have metastases to the liver. The fact is, most cancers in the colorectal area grow slowly. In fact 2/3 of the people who die from this cancer actually lose their live because of the tumors that have spread to the liver. For this reason, unless the patient has a bowel obstruction, a lot of doctors choose now to focus on the liver first and schedule a colon resection later.
So this advocate goes to a medical education event. This is a meeting where doctors can fulfill their requirements to engage in ongoing education in their field of study. Before the lecture began, my friend was chatting with two surgeons who focus on colon resection, and mentioned the newer approach of, when possible, delaying colon surgery. Both surgeons rejected this approach, saying they always do the colon surgery first.
The lecture started and the presenter—a top-notch surgeon—happened to address this specific issue. He showed data proving that patients have a better outcome if the treatment team is able to focus on the liver first rather that jumping straight into colon resection. My friend looked over her shoulder to see how the two surgeons were taking this information, thinking they would now see that they should change their practices. Instead, they two doctors were standing at the back of the room drinking coffee, eating snacks, and talking with each other. They had not looked at the data or heard the information. Of course they still received their education credits for attending the meeting.
What is the moral of this story? The field of medicine is changing quickly, and very few doctors can keep up with everything. Bottom line—patients need to find a treatment team in whom they have confidence and with whom they feel comfortable. But they should never, ever accept the treatment protocols without asking questions and learning for themselves what the current standards of care are for their disease. This does not mean second guessing the doctor, but it might mean saying, “I know you are planning this chemotherapy regimen, but I have heard that some people take this other regimen. Why choose one over the other?”
Trust, I believe, is important. It builds confidence and hope. It encourages patients to stick with the treatment when it is long past fun or even tolerable. But blind obedience driven by an assumption that “the doctor knows best” is a crapshoot at best. You might come up lucky, but then again….
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