Dec 15, 2015
James Randolph “Randy” Hillard, MD, is a Professor of Psychiatry at the Michigan State University (MSU) Colleges of Medicine. In 2010, he was diagnosed with HER2, stage IV metastatic gastric cancer, caused by Helicobacter pylori, and kept in check, so far, by trastuzumab. Before getting sick, he was Associate Provost for Health at MSU, responsible for the MD, DO, and Nursing Colleges. He joined ASCO in 2015 as an Allied Physician/Doctoral Scientist member to advance his work in education and advocacy for better prevention, detection, and treatment for stomach cancer.
AC: You’ve described yourself as “obsessed with oncology.” What led you to join ASCO as an Allied Physician/Doctoral Scientist member?
JRH: At this time in my life, I find the developments in both the basic and clinical science of oncology to be the most fascinating in medicine. My first ASCO meeting was the Gastrointestinal (GI) Cancers Symposium in 2014, where I heard a lecture by David Y. Graham about Helicobacter pylori as a target for stomach cancer prevention. Since then, one of my main purposes in life has been prevention of stomach cancer. Last year, I again attended the GI Cancers Symposium, as well as the ASCO Annual Meeting. Attending the meetings has been great. I even made a poster presentation last year.
In addition, I have been working with the ASCO State/Regional Affiliate in Michigan on getting appropriate biosimilar medication substitution and oral chemotherapy parity legislation passed in our state. I have been able to make connections with oncologists across the country who are concerned about the same issues that concern me. It has also been fun for me to write my blog on ASCOconnection.org! [You can read Dr. Hillard’s posts here.]
AC: What led you to psychiatry as a career path?
JRH: “I used to think the human brain was the most fascinating part of the body. Then I realized, well, look what’s telling me that.”—Dr. Katz, Professional Therapist (Comedy Central, 1995).
I seriously considered going into oncology, but that was the 1970s. At that time, cancer treatments had such devastating side effects and had such generally disappointing outcomes that I did not think that I could handle it emotionally. I was also unsure whether I could handle the chronic sleep deprivation associated with oncology training.
AC: Describe your typical work day.
JRH: Right now, I am on my once-in-alifetime sabbatical, so I am spending all my time studying and writing. Before starting that, I was spending about half of my time seeing patients and the other half teaching and doing research.
Recently, I was spending part of my clinical time working with students at the MSU Student Health Center, and the other part of my clinical time working with patients at hospice. That was a nice balance. At student health, I would see patients for 1 hour for the first session and for 15 to 30 minutes at subsequent visits. The “worried well” generally got managed by psychologists. For that reason, most of my patients had significant illness and needed medication in addition to counseling.
Most psychiatrists work in more than one setting, which keeps things interesting. Some other areas I have worked in include psychiatric emergency services, telepsychiatry to a community mental health center, and consultation to other specialties. I have been working with a number of patients recently who were dealing with cancer.
AC: What part of your job is your favorite? What aspect is the most challenging?
JRH: My favorite part is that in psychiatry we get to spend more time with our patients than most other doctors, and we get to get to know them better. My daughter, when she was a child, once told me, “You have a great job. You get to sit around in a big office all day and talk to people.” Of course, that is not the whole story, but it really is part of the story.
My psychotherapeutic approach is to treat my patients like they are sane and my colleagues like they are insane. That approach works almost all the time.
My least favorite activities have had to do with involuntarily hospitalizing patients. Fortunately, I have not had to do that in my recent jobs.
AC: How has your personal experience with cancer informed your professional outlook?
JRH: In 2010, when I was first diagnosed with metastatic stomach cancer, I really did start planning how I would kill myself. There is an assisted suicide organization in Switzerland that still has a file on me. I am, of course, glad that I did not go that route, and I no longer am concerned that suicide is in my future. My thinking at the time seemed completely rational to me, although I now realize how out of my mind I was. I now have a much deeper understanding of how rational people can become irrational in the face of overwhelming adversity.
I have also realized how unbalanced my sense of self-worth had been for so long. I spent most of my life being a careerist robot, but have now realized what a waste of time that was. I now pay more attention to my relationships with those I love and to trying to be consistently kind. I try to help other people figure this out without having to become sick.
AC: What role do psychiatrists and psychologists play in the interdisciplinary team helping patients with cancer?
JRH: One of the most important ways we can be helpful is aiding in the differential diagnosis between normal stress reactions and major depressive disorder in patients with cancer. Sometimes, we can even help oncologists, who all experience major stresses all the time, to make that differential diagnosis on themselves.
AC: What should trainee and earlycareer oncologists know about working with mental health specialists in order to provide the best wholeperson care to their patients?
JRH: There is still, unfortunately, a lot of stigma to seeing a psychiatrist, particularly among older individuals, who make up the bulk of oncology practice. Referral to a psychiatrist may be perceived as sort of an insult.
The message to get across is that everybody facing a cancer diagnosis, even the very strongest among us, has a lot to deal with and needs to be able to access all the help available. Practice positioning the referral to your patients as, “The doctor [psychiatrist] I am recommending can probably be very helpful to you.”
AC: What other advice would you offer to young professionals beginning their careers in oncology?
JRH: All residents and early-career physicians need to have an alternative specialty to think about going into if they get to the point where they cannot pursue their present specialty any longer. Psychiatry is a good alternative specialty to use for that purpose. (During residency, my alternative specialty was dermatology, since all the pathology was right out on the surface.)
Dr. Hillard was honored by the American Cancer Society as one of its “100 Stories of Hope” in celebration of its 100th anniversary. He has been a frequent contributor to ASCOconnection.org (select “Commentary” to read his blog) and Cancer.Net, ASCO’s patient-information website.