On a weekend mid-morning, I was flipping through radio stations as I
drove to our local farmer’s market. I finally settled on National Public
Radio’s “Car Talk” and treated myself to a few minutes of Click
and Clack for the rest of my drive. Many of you undoubtedly are familiar with
the two car gurus — brothers, MIT grads, hosts of a popular call-in radio
show, and experts about all things cars. I marveled at their diagnostic skills,
as they quickly pinpointed their callers’ problems, one after another,
sight unseen, with little to no objective data to go by. I remembered a
colleague joking that he wished he could be half the diagnostician as a doctor
that Click and Clack were as automotive experts.
What struck me that morning, though, was how informed and perceptive the
callers were about their cars — and how adept Click and Clack were about
breaking down very complex problems into digestible information that their
callers could understand. I started to think about the parallels between a car
and a human body — and began to think about oncology and patient education
in a new way. Could one imagine an NPR call-in show with an oncologist
answering questions from patients and family members?
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William
Wood
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When I was a senior resident — having been trained in good
hospitals in internal medicine and pediatrics — many of the concepts of
clinical oncology were still pretty foreign to me and even several of my
supervising attendings. We struggled to understand our patients’
prognoses, and we viewed with skepticism the decisions to treat some of our
older patients who had incurable diseases and other medical problems. I think
this was because we didn’t clearly understand the subtleties of
decision-making in clinical oncology — or the benefits that our patients
might realize with certain kinds of treatment, palliative or otherwise, even
when cure wasn’t a possibility.
I don’t think it was until part of the way through my first year of
fellowship that I finally started to “get it” — when I began to
think not just as an internist, but as an oncologist. And in reflecting back on
educational principles, I understood that this was because through those first
few months I had developed — through exposure and repetition — a
context in which to assimilate the facts and concepts of the discipline.
If it was that difficult for me to grasp the tenets of clinical oncology
after four years of medical school and another four of residency then what must
it be like for my patients? In the clinic, we try to teach our patients what
they need to know to take care of themselves and to live with their diseases,
as hard as it may be, but what do they really understand? Do they know their
bodies and their afflictions in the same way that many of Click and
Clack’s callers know their cars?
After reading one of my columns, Dr. Richard Frank, the head of oncology
at Norwalk Hospital in Connecticut, mailed me a copy of his recent book,
Fighting Cancer with Knowledge and Hope. Conveniently, I was
traveling to Boston on a plane around that time and I had a chance to read
through it. Admittedly, I’m not an expert in patient education or health
communication, and I’m not familiar with other books in this genre, but I
really liked Dr. Frank’s book and thought it worth mentioning in this
column.
The reason has to do with what I’ve talked about so far — in
this book, the author provides a framework to help the reader understand the
basics, all of the basics, about clinical oncology so that the reader can know
his or her own disease in context. It makes sense, given the author’s
background — he was previously a basic scientist at Memorial Sloan
Kettering and was used to explaining highly complex biological processes to
trainees. In the sciences, one has to know the background to understand the
problem at hand.
I think that the approach in this book is a little different than the
usual approach in clinic, for two reasons. First, there’s clearly far more
that a reader could learn through thoughtful reflection upon 200 pages of
printed material than via the time limitations of a clinic visit. But second,
and this is where I was most intrigued, the idea here is that the learner needs
to go through the whole course to master a topic. In addressing all issues
— TNM staging, cancer biology, metastasis, diet, exercise, the goals of
treatment, successful survivorship — the author anticipates common
questions, addresses frequent misconceptions and provides thoughtful
explanation throughout. Even more provocative, as the title implies, is that
“knowledge” is as equal an ally in the battle against cancer as is
“hope.”
I’m not sure how one would test these hypotheses: By acquiring a
deeper repertoire of general cancer knowledge, are patients more hopeful? Do
they live better? I don’t know the answers, but I think that interested
patients could learn a lot from reading Dr. Frank’s book. And, if they
would then be able to push their doctors with the kinds of insightful questions
that Click and Clack regularly get from their listeners, I think that this
could only be a good thing for all involved.
William Wood, MD, is a third-year hematology/oncology fellow at the
University of North Carolina Chapel Hill and is a member of the HemOnc Today
Editorial Board.