Psychology and science

In my view, the ideal physician is one who combines caring, compassion, empathy and introspection with hard core science. It is all too easy to become fascinated by the “mind over matter” paradigm and delude one’s self into thinking that a positive attitude will solve some very basic problem (like a mutation in DNA…). That said, I have little doubt that patients with a positive attitude generally enjoy their lives and whatever time they have left with friends and families more than those who become obsessed with one disease or another and launch on an endless search for an answer that probably doesn’t exist. My own experience with cancer in my parents, siblings and self has taught me that equanimity is one of the most essential characteristics of the cancer survivor. We all survive (with luck) various insults in our genomes or our environments for only so long, and then we move on. I will turn 65 this summer, and it is hard for me to internalize the reality that (again with luck) I may have only about 20 or so more years to enjoy this wonderful planet. Like everyone else, my mind tells me I will go on forever, but the harsh reality of 20 years is just plain difficult to internalize. Are you kidding me? 1992 seems like only yesterday!

Today I received an email from a colleague with a link to this website that is written by a psychologist. It seems to have lots of good resources, and I recommend it on your journey. Perhaps Dr. Pope will have helped winnow down the avalanche of information out there for you as well. Good luck!

6 Comments

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6 responses to “Psychology and science

  1. Tim Roels

    Welcome to the real Senior Citizen corps!! When will you be on Whiskey Hill this spring and summer?? Looking forward to seeing you then, Things are good in Texas!!
    Regards, Tim and Barb

  2. recbeck

    Dr. Glode, I agree “mind over matter” is like sticking one’s head in the sand! Cancer has little room for mindless wishing. Advanced cancer patients can only rely on their own researh for new upcoming breakthroughs, our doctor’s expertise , knowledge and mostly their experience in treating their cancer. When you give your patient a 3 to 5 year window to live, well….. now what do we have to look forward to? A younger man with advanced PCa has just been told they will not live to be old, see their kids grow up and enjoy “old age”. You stated, ” those who become obsessed with one disease or another and launch on an endless search for an answer that probably doesn’t exist”. I disagree! New breakthroughs in PCa are happening every day that is turning a terminal disease like PCa into a chronic disease. The reason I can make it day to day is a word you negliected to mention : “HOPE”! Hope is new breakthroughs like Zytiga, Provenge, E-patches, Denosomab and what new drug or procedure that will be released next. I would bet your thoughts on your potential chance of cancer not to spread, (CTC’s) is driven by “Hope”. I feel one of the most important thoughts a doctor should instill in their patient is to never give up hope! Keep up the good work. We are counting on you! Craig

  3. Dan

    Dr Glode ,
    Thank You for the link to an excellent resource for the prostate Cancer patient.
    The hope is through becoming an informed patient that we are able to make it to the right side of the survival curve ,hopefully making the tail.
    I know how you feel with the 20 years.
    When I was diagnosed m1b with High grade stage 4 ProstateCancer 6 years ago, I foolishly asked the Doctor about my prognosis, and he compassionatly told me that I had at least five years but that I surely did not have 20 years . A month later his nurse called and told Me to get my things in order. I told her I appreciate the advice but I plan to live much longer than the 1 year she gave me. She said “thats nice but most don’t. Since then I have never asked. Since then I know it was good Drs. who were willing to think out of the box that have got me this far.
    I would like to add another link that I think is very important to understand as a Cancer patient. That being an essay by the late Stephen J Gould titled “The median is not the message” You may need to paste into a browser.
    http://www.phoenix5.org/articles/GouldMessage.html

  4. I certainly don’t advocate giving up hope, and I am very aware of the Stephen J Gould article that points out there is always a “tail” on the survival curve. What I am arguing for is equanimity. I had meant to put in a link to this article: “Why Doctors Die Differently“. In it, Dr. Murray describes numerous circumstances regarding physicians’ attempts to meet their patients’ wishes. Medicine is an art. It is also a science. On the science side, one can apply statistics. When a patient asks me, “How long do I have?” I think it is fair to tell him/her the range of expectations. I don’t regard this as taking away hope. Many times a patient will tell me “you said I only had 5 years, and it has been 10 already…” Since I virtually never give a single number, only a range, it tells me that patients hear only part of what we say. I almost always couch such discussions with an anecdote about the tail of the curve as well….”I am taking care of a patient just like you who is still alive and doing well at year 15.” BUT – just as I would say to Steven Gould, it is only fair for you to know the general outcome. I often care for patients who “belong to” a colleague who never has a discussion about the end of life. This physician always tries something else and never gives up until the patient is so sick that they need to be admitted to the hospital. When it is then my responsibility to discuss end of life issues with the patient or the family, I always call the physician and ask whether this will be appropriate. Invariably the answer is “yes”, by all means. Is that fair? Should it be a doctor who doesn’t know the family well who sits down at the bedside and goes over the fact that there really isn’t much else to offer? Is it appropriate to prescribe a drug that might have a 1% chance of prolonging life, but a 90% chance of making someone miserable? I feel these decisions should be in the hands of the patient, but I also think it isn’t appropriate just to reach for another drug on the outside chance that “hope” comes in a bottle. No one wants to hear bad news, and indeed there is much good news in the realm of prostate cancer treatment in the past year. However, we all inherited a fatal disease called “life”, and admitting this to ourselves is what I mean by equanimity. In the end (the real “end”) how we die may be as important as how we live.

    • Dan

      Dr Glode,
      Thank You for your reply, I understand what you are saying.
      It is a hard thing to be the one to break the news to the patient.
      I must admit accepting my own mortality has allowed Me to live my life to the fullest.
      I know you are a wonderfully compassionate Doctor , And it makes Me wish that I lived in Colorado.
      Thank You for your wonderful work in Prostate Cancer.
      sincerely,
      Dan

      • Dan

        Dr Murrays link really makes a good point for us.
        It sheds a different light on having do not resuscitate paperwork in order.
        Dan

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