One of the things I enjoy as an academic oncologist is the opportunity to teach. I like having students, residents, and fellows in my clinic and the opportunity for them to see what oncology is and what we do; how we "marry" the art and science of medicine in our routine care of patients with cancer.
For several years, I've co-directed an elective at the medical school for senior students, which exposes them to the interdisciplinary care of women with cancer. It was a course I had offered at the Alpert Medical School of Brown University, and I was happy that my friend, Marcela del Carmen, agreed to co-direct this course at Harvard Medical School.
This month my group welcomed Jeehey Song to our interdisciplinary practice. Jeehey is a visiting medical student from South Korea. Despite being from South Korea, her English was impeccable, which is likely as a result of her completing her undergraduate studies at Cornell University. I had been considering ways to encourage students to pursue a career in oncology and had decided to ask Jeehey her thoughts. In an email to me regarding her interest in Oncology, Jeehey responded as follows:
"Honestly—I wasn't very interested in oncology before I got here. I think it's partly because I still carry this somewhat old (though not entirely untrue) notion that all cancer is terminal. Despite the concept that one can overcome cancer, that early stage cancer is in fact curable, once people have had cancer, they're still at risk for a recurrence, which is obviously a different situation for them and their families from before cancer.
“I wouldn't call this general, but in my specific case, the cancer patients I'd encountered in Korea weren't women with a gynecologic cancer; they tended to have a hematologic or GI cancer, and this concept of cancer as terminal could have been due to the fact that my first few encounters in oncology were with patients diagnosed with very advanced cancers, and I wasn't around to follow up on their cases (whether they were offered to go on clinical trial and etc.). I saw some very unfortunate cases of rather young patients without much option for treatment."
This had struck something inside of me because a similar experience first made me consider a career in oncology. Back then, it was my encounter with a young man with lymphoma, who was being treated at the University of Rochester. Even though over 20 years has passed, I still remember his anguish as he was admitted to the hospital for treatment, the questions of why this happened to him, and his fears for what would happen next. I also recalled how the attending had sat with the patient, pulled up a chair to his bedside so they were eye-level, placed his hand on this young man's shoulder, and talked with him about treatment, evidence, and—perhaps most importantly—a future. I had been struck by the rawness of the situation, which helped me see that our job as doctors is not only to address medical issues, but the psychosocial consequences of illness as well.
Wondering if she had been left with a similar impression after working with the surgeons, medical specialists, and radiation oncologists in Gynecologic Oncology, Jeehey emailed me:
"One of the first things that caught my attention is feeling the reality of evidence-based medicine in treatment planning for patients in the clinic. I've heard and learned about the whole notion of evidence-based medicine in school, but I guess it felt more like an idea or something abstract during my training in Korea. It might have been that I just was never exposed to a clinical situation where attendings made decisions about patient treatment based on recent studies. I was struck by how all of the attendings applied and explained specific results and findings of clinical studies or trials to the treatment options and planning for patients and their families. It really impressed upon me how evidence-based medicine applies in clinical practice.
“For example, I've noticed that when the attendings here discuss treatment options with women diagnosed with recurrent disease, they tend not to give any guarantees. Although the evidence is applied when discussing treatment options, I have heard multiple times that there is always a chance things will turn in unexpected directions and that they (the attendings and the patients) cannot know what will happen with any certainty until treatment has started. In this sense, I feel although we have learned so much about cancer, we always have to let the patients and their families know that the results from studies is no guarantee; that things may be different for her.
“Finally, I have noticed that patients here are able to spend more time with their physicians, discussing what has happened, what can be expected in the future and treatment options/plans.”
Although Jeehey was not prepared to declare herself a budding gynecologic oncologist, I was struck by her experience in our elective, and how it brought back to mind the very things that drew me to the profession so many years ago—that the science and art of medicine is a real interplay between doctors and patients. As one of the challenges in oncology care is to meet the projected shortage of oncologists for the future, perhaps those of us in academic oncology should make it a point to reach out to the younger generation—not only to those in residency, but those still in medical schools. Together with ASCO’s opportunity for medical students and residents to become members of the society, I am hopeful we can do our part to help ensure that the future needs of our profession and our patients are met as well.
Afterall, impressions can be quite a powerful thing.