How Does the Doctor Feel?

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To the Editor:
When the words “You have cancer,” “Your wife’s cancer has metastasized,” or “Your son’s tumor is not responding to treatment,” are spoken, no one can be prepared for the emotional aftermath that ensues. Some will erupt in molten spews of anger, betrayal, and disbelief. Others will drown under the rivers that flow alongside grief-stricken sobs. Some will only exhale a small wind that is hardly representative of the fear and shock being harbored under their expressionless stares. A journey with cancer is one unparalleled to most hardships in life, both in the emotional tolls it takes on those involved and in its inescapable prevalence in everyone’s life as they assume the role of the patient or the caregiver.
When someone’s world is suddenly flipped upside down, we are—expectedly—quick to run to their side, offering supportive hugs and any words of strength we can think of. But who comforts the physician, who just mustered the courage to face a patient and deliver such devastating news?
In a field fighting an incurable disease, cancer health care providers perhaps experience the most emotional turmoil of all medical specialists.1 Lung cancer teams in particular are no stranger to this as they combat the deadliest cancer in both genders. Each member of this team—whether it is the primary oncologist, an interventional pulmonologist, a radiation oncologist, or a thoracic surgeon—must especially possess the compassion and patience necessary to interact with terminally-ill patients every day. However, it is this compassion that leaves them vulnerable to emotional distress.2 In a given day, good news will be shared with a patient, whether it is a cancer-free imaging, a successful surgery, or a fifth year of a lung cancer not relapsing. But for every little triumph, there is at least 1 looming setback or complication to match.
There is a disparity in the literature of the last 15 years between the emotional tolls suffered by patients and their oncologists that desperately calls out 1 question—how does the doctor feel? It is easy to quickly search through the internet and find studies on physician burnout, reports on physicians’ opinions toward novel treatments, or summaries of programs established to train residents for the emotional hardships of their future professions.1 However, these articles all circumvent the 1 missing piece of information; only a handful of anecdotal papers can be found showcasing what it is truly like to be part of a cancer team.3 Fewer yet describe the unique environment of a particular cancer subspecialty, such as lung cancer, that distinguishes it from working in other subspecialties. The doctor is half of the patient-doctor relationship, yet there are countless more articles citing the emotional journey a cancer patient experiences in the double-sided battle.
As in any subspecialty, the lung oncologist builds a relationship with each one of his patients over time; he will learn about their personal lives as they battle the cancer together. It often becomes a personal mission for every member of his team to find the right treatment for the patient. It will become a personal failure when the treatment does not work or causes damage to the lung. He will face the battle of lung cancer hundreds of times throughout his career and will watch dozens of patients suffer until they finally admit defeat, each time losing a life he had established a connection with. Current papers that mention long working hours, a fast-paced environment, and other shortcomings to the job do not justly encompass the emotional ups and downs of being an oncologist.1,2,4
The lack of personal anecdotes in the literature may be attributed to the term “burnout.
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