Decision Making For The Cancer Patient – My Guiding Philosophy

This article is an insight into my personal philosophy when helping cancer patients make difficult treatment decisions.

Cancer patients and their loved ones are faced with tough choices throughout the course of the disease.

  • Should my 75-year-old father take treatment for his lymphoma, or should I just let him be?
  • Should I opt for surgery or for radiotherapy to treat my prostate cancer?
  • Should I choose breast-conserving surgery or mastectomy for my breast cancer?
  • Should I go for adjuvant chemotherapy after my pancreatic cancer operation, or should I just observe?

Sometimes, decision-making is simple, and there is no doubt about the choice to be made. But, many a time, arriving at the right decision is not easy. Theoretically, there may be advantages and disadvantages of each particular choice of treatment. A “cafeteria approach” where the patient is presented with a “basket of choices” and asked to choose among them may not always be helpful to the patient. The other extreme is a “paternalistic approach” where the treating doctor unilaterally decides what is best for their patient.

An important role of a doctor is to help a patient and their family arrive at a decision that is right for them, which may even include getting a second opinion.

Very often, after a detailed discussion with my patients, when I finally lay out the options in front of them, they ask – “Doctor, forget all the pros and cons. Just tell us which option do you advise?”

In the early part of my career, I would be wary of such a question. I may have said – “I can’t make the decision for you”. Or “Let me explain all the facts again, then you can decide”. I would even sometimes feel “I don’t want to make a decision on their behalf, and get blamed if things go wrong.”

Down the years, I have matured enough to understand that the patient is not trying to put me in a fix. It is simply their way of saying “Help me – I don’t know what to do”

Over the last two decades, whenever I have mentored my students and junior colleagues, I have tried to imbibe them with this philosophy – whenever you give a choice to a patient or family, think what you would do in their place – and guide them accordingly.

So when someone asks me “What should I do?”, I put myself in their shoes, think hard, and tell them “If I were you, this is what I would do – ”

2 thoughts on “Decision Making For The Cancer Patient – My Guiding Philosophy”

  1. This is sooo right doctor. As a patient or family we don’t know and also not qualified in any sense to make this decision and trust our doctor completely to help us decide. We are not trying to put the decision on the doctor for blame but for guidance and help.

    Reply
  2. This is Chidambaram here and I am a teacher
    In a high school . I had an ulcer in the tongue
    (Left inner edge) in 2012 and happened to
    slowly enlarge . I was apprehensive about a
    biopsy test as my intuition said it’s going to be
    cancer. Fear gripped and I assumed if I went
    ahead with surgery I won’t be be able to speak
    again which would be the end of my teaching
    career. Upon deciding to face reality , I went ahead
    with a biopsy test and it proved to be negative.
    I was advised to take another opinion as the ulcer
    did not seem visually fine . I went to st.John’s hospital
    and met Dr Suraj Manjunath. I felt comfortable and connected
    the very first meet . Upon encountering my fear for loss of
    speech post surgery , he helped me witness people with
    similar issues doing well post surgery . This pepped up my
    courage in going ahead with the surgery which took place
    on July 2016 (four and half hours).
    I must say that Dr Suraj Manjunath is a God sent person.
    A simpleton and a great human being for helping me tread
    this uphill task . Here I am post surgery and periodic check up
    continuing my teaching career .
    I am truly thankful to Dr Suraj Manjunath for having taken me through
    this course successfully.
    Regards
    Chidambaram

    Reply

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