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Dealing With Life-Threatening Illness From Both A Doctor And Patient’s Perspective

Evening Edition

Aired 2/11/14 on KPBS Midday Edition.

GUESTS:

Scott Irwin, MD, Ph.D., Director, Psychiatry & Psychosocial Services; Patient & Family Support Services, UC San Diego Moores Cancer Center.

Sandy Ramos, MD, is an OBGYN at UC San Diego Health System. She just finished treatment for breast cancer

Transcript

Frequently on Midday Edition, we highlight the amazing medical advances being made by researchers here in San Diego. Those breakthroughs often give hope to people fighting serious disease.

But patients don't always win their battles with disease, and when a terminal diagnosis is made, people ask their doctors one question: How long do I have to live?

A recent Op/Ed piece in The New York Times highlighted this dilemma for both doctor and patient.

That editorial was written by Dr. Paul Kalanithi, a chief resident in neurosurgery at Stanford hospital who also has terminal lung cancer.

Kalanithi said in the editorial: "[Doctors] never cite detailed statistics, and usually advise against Googling survival numbers, assuming the average patient doesn’t possess a nuanced understanding of statistics."

"One would think, then, that when my oncologist sat by my bedside to meet me, I would not immediately demand information on survival statistics," he said. "But now that I had traversed the line from doctor to patient, I had the same yearning for the numbers all patients ask for."

Should doctors be more forthcoming about what they know about patient survival? How should patients translate that information into their own lives?

Dr. Scott Irwin, directs psychiatry and psychosocial services for UC San Diego Moores Cancer Center.

Irwin said, in general, doctors are not trained well in communication techniques or in taking care of dying people.

He said some doctors prefer to be vague about a terminal diagnosis because they're afraid of taking away hope.

Instead, Irwin said, many doctors like to quote survival curves.

"What I like to tell patients is we don't know which 50 percent you will be in," he said. "We will do everything we have to offer, that you want to do, to try to keep you in the 50 percent that survives."

He said he also tells patients to hope for the best but to plan for the worst.

Dr. Sandy Ramos is an OB-GYN at UC San Diego. She also has stage-three breast cancer, and completed treatment in December of last year.

"As a physician you have different perspective being diagnosed with something as life altering as cancer," Ramos said.

She said it took her some time before she asked about her prognosis.

"My perspective was, 'no matter what, I'm going to be fine,'" Ramos said. "'I'm going to be my own statistic.'"

Ramos said life has not changed that much since her diagnosis. She's more conscious of the people who support and love her and expresses thanks and love more often.

"Every morning I wake up and think, 'wow, I have stage-three cancer," she said. "But at the same time, I take a deep breath; there's no other option than to keep living."

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