I am dying from the treatment of too many physicians~ Alexander the Great
When a doctor tells you you have cancer (or any life-threatening illness) your natural reaction is to ask him or her, “What should I do?” You’ve just been thrown into uncharted waters, with nothing to guide you but your desire to survive. You’re devastated and panic-stricken. And so you look instinctively to the first “expert” — the doctor who gave you the news — to help you figure out what to do.
More than likely, your instincts will also urge you to follow this doctor’s advice, especially if he or she urges you to move forward with treatment with little or no delay.
But while this may be the natural response to a terrifying diagnosis, it is rarely a good idea.
Michael was a 55-year-old man who for several months had been suffering from several unexplained symptoms: back pain, a sore throat and an increasingly bothersome pain in his chest. He had visited his primary doctor a number of times, who first ruled out any heart issues. Then he referred him to a physical therapist for his back and chest pain and an ear-nose-and-throat doctor for his persistent sore throat.
Michael visited the physical therapist, who recommended muscle strengthening exercises for his back and chest pain. Next, he saw the ENT doctor, who looked in his throat with a special instrument and saw a small but “suspicious” lesion. The doctor ordered a CT scan.
The results of the scan showed a small tumor in the back of Michael’s throat and numerous lesions in the bones of his spine and chest.
When the ENT doctor met with Michael to discuss the results of his scan, I was there. The doctor told him he had thyroid cancer, and recommended surgery to biopsy the lesions immediately. Because I have an oncology background, I asked the doctor what he thought about the bone lesions, which were not consistent with thyroid cancer at all. Amazingly, the doctor said they were probably evidence of a second, separate cancer — possibly prostate cancer that had spread to his bones.
Fortunately, Michael had asked his primary doctor to do a prostate-specific antigen blood test just a few months before. The results were normal, which meant the prostate cancer theory could not possibly be right. I begged Michael to get a second opinion. Despite his sense of urgency and desire to have answers right away, he agreed.
Michael waited three weeks for an appointment with a specialist at a local cancer center. The wait was agonizing for him. But those three weeks saved him from unnecessary surgery, and possibly saved his life, because Michael did not have thyroid cancer and some mysterious second cancer. He had multiple myeloma, a rare blood cancer that invades both soft tissue (like the throat) and bones.
Michael is now receiving treatment for his condition, and is doing well.
Michael’s story is not at all unusual. In fact, according to a recent study at Johns Hopkins Hospital in Baltimore, Maryland, up to 1.5 percent of the 1.3 million cancer diagnoses made in the United States each year are wrong. And that’s after a pathologist has looked at the tissue under a microscope. No one is really sure how many patients are told they have cancer, undergo a biopsy and then learn the diagnosis was incorrect.
But here’s one clue as to how widespread the problem is. An article in the October 2016 issue of the prestigious New England Journal of Medicine says that over half of the breast cancers detected by screening mammography in the United States do not require treatment. But according to current cancer-care standards, virtually all will receive treatment of some kind. In fact, the study concluded that “women were more likely to have breast cancer that was over-diagnosed [and over-treated] than to have earlier detection of a tumor that was destined to become large.”
Of course, there are times when a person with cancer is so sick at the time of the diagnosis that emergency treatment is essential. Doctors may need to start some kind of therapy so they can get well enough to participate in discussions about what to do next. But even then, it is not always in the patient’s best interests to go “full speed ahead” with curative care. Evidence suggests that older, frailer cancer patients get little benefit from aggressive therapy. In fact, many of them die during the first weeks of treatment. And those who do survive have a poor quality of life.
There is no denying that “cancer” is a big scary word. But it is unwise and imprudent to let fear dictate how you will live — or how you choose to die. What’s more, getting a second opinion is not an insult to your doctor. In fact, any doctor who objects to your consulting another physician is almost certainly a doctor you want to avoid.
If you’ve just been diagnosed with a life-threatening illness, take a moment to catch your breath, and ask your doctor all of the questions you need to ask. Then get a second opinion, and if you’re still unsure, get a third. This is one of the most important decisions you will ever make. Take your time.
Each month Kathleen Clohessy, R.N., offers a new perspective on living with a terminal illness. Kathleen comes to SevenPonds with 25 years experience as a registered nurse caring for families and children facing life-threatening illness. She began her career in the Pediatric Intensive Care Unit at Nassau County Medical Center in New York. After relocating to California, she spent 15 years as an R.N. and Assistant Nurse Manager at the Pediatric Oncology & Bone Marrow Transplant Unit at Lucille Salter Packard Children’s Hospital at Stanford. She uses her knowledge and expertise to enlighten our readers about the challenges associated with chronic illness and its effects on family relationships.