By Matthew T. Ballo, M.D., associate professor, Department of Radiation Oncology, MD Anderson Regional Care Center in the Bay Area
"Medicine should be seen primarily as caring for people's health rather than as fighting a war against disease."
- Virginia L. Warren, Ph.D
From the 'Medicine is War' Metaphor*
I first read these words almost 20 years ago and the message has had a lasting effect. The idea that we should think of our clinics as environments for caring for patients, rather than arenas for fighting, would seem obvious but does require some effort.
The thought of waging a war against cancer has an appeal to physicians and patients, for it raises images of an aggressive attack on an unrelenting enemy. It fulfills for physicians the desire to apply their skill in treatment, while for patients their desire for cure.
However, even with the best of intentions, the military metaphor overlooks the fact that patients sit at the center of this battlefield and disregards the gravity of collateral damage. Rather than speaking of how we are going to eliminate a patient's cancer, the conversation should focus on returning that patient to normal -- where cure is only one of many essential objectives. Taking the high road
Three years ago, we created a lifestyle rehabilitation program (The Road to Wellness Program
) as part of a caring environment for patients receiving cancer treatment. The idea was to promote wellness, prepare patients for life without cancer, and reduce stress and fatigue -- all through education aimed at exercise, nutrition, stress management and smoking cessation.
While this concept may not seem particularly groundbreaking in the era of survivorship
and patient advocacy, it has required some change in our approach to patients receiving radiation treatments.
Traditionally, if a patient develops a specific need during radiation treatment, it is addressed by consultation with the appropriate ancillary care service. This model of intervention works well and serves the immediate needs of patients and care providers. However, it often does little to prepare patients for issues that may arise after treatment is compete. The motivation behind this model is reaction and the primary focus is to facilitate completion of treatment.
Striking a balance
In the alternative model where caring is stressed, long-term patient needs, be they physical, psychological, social, spiritual or economic, are addressed proactively. General wellness is stressed just as much as radiation treatment, so that one is not viewed as more important than the other.
A simple change in mind set where medicine is not viewed as a battle can permeate the treatment phase of the cancer journey and have lasting effects on our patients. When we consciously avoid the "medicine is war" metaphor and focus on wellness, we leave behind the negative imagery of destruction and create an environment where patients are returning to something familiar rather than moving into something unknown.
Source: *Warren, VL. HEC Forum 1991;3:39-50