Personalized Medicine

To help manage the stress of treating people with life-threatening diseases, doctors are trained to limit the emotions they invest in patients.

As young oncologists, Dr. Rachna Shroff and Dr. Nina Shah followed professional protocol by the book. They kept patients at an arm’s length, in fear of blurring what they felt was an important line between doctor and friend. That all changed when each of their roles were reversed; the doctors became daughters to a parent with cancer.

In this episode of Your Stories, the friends and colleagues discuss how their experiences on the other side of the bench inspired changes in the relationships they allow themselves to develop with patients.

To help people manage the stress of treating people with life-threatening diseases, doctors are trained to limit the emotions they invest in patients. As young oncologists, Dr. Rachna Shroff and Dr. Nina Shah followed professional protocol by the book. They kept patients at an arm's length in fear of blurring what they felt was an important line between doctor and friend. That all changed when each of their roles were reversed.

The doctors became daughters to a patient with cancer. In this episode of Your Stories, the friends and colleagues discuss how their experiences on the other side of the bench inspired changes in the relationships they allow themselves to develop with patients.

What were you like as a fresh, young oncologist?

I definitely remember being energized and ready to take on the oncology world taking care of pancreatic cancer patients and seeing the human side of oncology and seeing the incredible need to help these patients and try to feel like I was making a lasting impact in the field. What about you?

One of the things I think that drew me the most to oncology was that I felt like I could have an impact on someone. When you start out as a young attending-- I call it being youngry-- you're young and hungry-- and you do so many things, but there are only 24 hours in a day.

So sometimes when you take care of patients, you're thinking, OK, I have to take care of this patient and then the next patient. And then, I started to really think about getting to the end of everything I was doing-- the next patient visit, the next paper, the end of writing that. I was starting to become a little bit more distant from the patients. Did you ever feel that way?

Absolutely. As young attendings, we felt that we needed to keep patients that a little bit of an arm's length and either to just maintain that sanctity of that work-life balance that everybody's trying to find as well as trying to prevent burnout. People talk about how, especially in oncology, the more you let somebody in, the harder and more profound you feel losses, the more prone you are to getting burnt out.

I remember thinking, I've got to pace myself here. This is a marathon, this journey of being an oncologist. I wanted to make sure that I was able to have the resilience to take care of all the patients over the course of my career.

You and I used to say this to each other. We've got to protect our spaces. If we get too involved in one thing, we won't have enough energy to get involved with the next patient or be a parent at home or take care of our spouses or our families. And I think we did start to put up a little barrier. We were just trying to be efficient. We were just trying to get everything done. It was hard. When do you think this changed for you?

When it started on the other side. My mother became the stereotypical, statistic, Asian, non-smoking female who got lung cancer. At that moment, I flipped from being the oncologist to being a daughter and a caregiver. I remember feeling so scared and vulnerable. It was a glimpse, at that moment, when I heard her diagnosis, into what patients hear when that diagnosis comes through.

I remember the agony of waiting in a waiting room to see the physician. I remember sitting in the radiology suite with my laptop, refreshing the cat scan images as she was in the scanner, so that I could look at the images and make sure that, after that surgery, that cancer was gone. I remember calling a radiologist on his cell phone to make sure that I got the read of that cat scan. What about you?

I think that it all started to change for me when my dad was diagnosed with cancer. I went through these three stages. The first was the, OK, I'm not going to deal with the emotions right now. I'm going to be functional, get him an appointment. And then the second part was the sadness. I saw my mom start to crumble knowing that he had a very bad diagnosis. And all of us started to be confronted with that reality. It's so different, right, when you're the patient's family member versus the physician.

The third part of it is, I really started to change as a physician. I appreciated the care. But I started to appreciate what it means to have to go through this, all the steps-- waiting in the waiting room, waiting for a doctor's decision, waiting for a result, waiting to see if the medicine works. Then the appreciation of caregiving-- this was something so new to me. I can't believe I didn't realize it until I saw my mom taking care of my dad for a very extended, intense period of time.

They were both around 70. And it's hard to do that. We take care of our kids, but we're much younger. I saw my mom taking him to appointments, rolling him into the car, and waiting to see the doctor. And sometimes I couldn't be with her, and she was just by herself. And she'd have to pack a lunch because, who knew how long the chemo and the blood draw was going to take?

I began to appreciate that I see my patients for 15 minutes in that office, and we talk about what's going to happen. And I walk out the door, and they walk out the door. And after that, the real work begins for the caregiver in an intense way that I didn't appreciate before. We see them every couple of weeks, right?

But we don't see that endless, infinite time in between. That was so impactful to me. I really began to not only speak to the patient, but the caregiver, and it really started to see it from both of their perspectives. And there's so many people who aren't even lucky enough to have a caregiver. And that, I even felt, even more, as an emptiness.

Having gone through this with your mom, how did you start to change, as a doctor?

Well, I think, like you said, I became more keenly aware of what that journey really is like for, not just the patient, but for that patient's entire circle. There were small things that-- even just the ways in which I would talk to patients that I changed. My mother got chemotherapy that I give all the time to my patients. And there's a hearing loss risk associated with it.

And I used to just kind of downplay it, and I'd say, it's incredibly rare; don't worry about it. And with one dose of that chemotherapy, my mom lost her hearing and got hearing aids. And immediately, from that day forward, there was a different way that I presented that chemotherapy to patients and wanted them to understand, it's a small risk, but it's a real risk. Losing your hearing is a big deal.

It's a quality-of-life issue. And when you're dealing with survivorship, the long-term impacts of these toxicities, we literally just fly through on a patient education handout. We have to think of the downstream effects. So I feel like I changed the way I present to those toxicities to patients. I just became more cognizant of the amount of agony that goes into these patients as they're waiting.

I used to walk into the patient's room and try to do my full history and physical before I would give them cat scan results. And I would see them looking at me going please, please, just tell me. Is this working, or is this not? And now I have a recognition of what those additional 5 to 10 minutes is to the patients.

I try my best to make sure that I give them the results-- the good, the bad, and the ugly-- in as timely of a fashion as I can, even if that means making sure that I'm calling them or following up with them. And I do. I'm willing to let them in a little bit. They have access to me, not just my clinical team. Because sometimes, when it was my mother, I needed to hear it from the doctor. There was something about the comfort of hearing it from that physician's mouth directly.

Yeah, after this experience with my dad, I've really begun to open up in a couple of ways. I feel more accessible. I give patients my cell phone number. I used to worry about that because, I would think, they are going to call me, and I'm going to be at my kid's birthday or something. They're so respectful. And I realized that it's a comfort. They know that I'm there for them. And I know that, if something happens, they're going to let me know, and I won't find out two weeks later.

I've also begun to understand that people wait for results, and it's agonizing. So I send a message to the patients, and they have it on their phone. And I can say, hey, I saw your bone marrow. It looks good. I'm happy, smiley face. And I sign it with my first name. I used to get so crazy about people calling me by my first name. I was insecure as a young woman physician.

And I thought, it just meant they didn't respect me. Now I just-- it means that they like me. It means they feel familiar with me. And I don't mind that anymore. I kind of take pride in it a little bit. I feel more connected to them. And it really does make it an experience for all of us. And it's really more rich.

What do you think has changed about how you approach clinical research?

Having had a loved one have cancer and have them receive the benefit of progress that has been made through clinical research, it is always at the forefront of my mind in the diseases that I treat. We need to be doing better. And I know that the only way we can be doing better is clinical research. Clinical trials are so incredibly labor-intensive from a patient perspective.

When there's a study that involves multiple blood draws, and you have to be at a infusion center for 10 hours, and then come back the next day and be there for six hours, that is a lot for a patient. And traveling, and you're paying for parking, and you have young kids, and you're trying to find childcare for your family so you can be there all day.

Yeah, I've appreciated that patients are not just patients. They're humans and that they are intellectual and have curiosity. And more now than ever, they've done their research, and they've looked up things. And they follow people on Twitter and look at your YouTube videos. And this has changed the discussion about clinical trials in my practice because they come to me, and they know what trial they want.

When I was a junior attending, I would have been put off by that because I would have felt that they might know something more than I do. We have now, I think, way better discussions than I was capable of having before because I let them into my mind too, not just my heart. I think these are things that we've been able to grow with as we've become more mature and maybe more open. What do you think you would tell a junior attending who's starting as an oncologist?

I would emphasize that it is not only OK, but it is important to let your patients in and to share the journey with them. Because what I've come to realize is, what seem like very small things for us to do are so incredibly meaningful to our patients. At the end of the day, these patients know that their lives are in your hands.

And it gives them faith and trust on a totally different level. You are initially thinking that letting your patients in makes it harder, it's more emotionally draining, and leads to burnout. I actually think it's the exact opposite. Developing those human interactions and relationships with these people and knowing who matters to them, what they love, what they're living for is actually invigorating.

It is exactly what is going to prevent burnout. You should not hold patients at an arm's distance, because there's so much that we can learn from them just as much as they can learn from us.

Yeah, if I had to tell myself 10 years ago, some advice, it would be, open your heart. Let people in. Let patients in. It's going to make you see all 360 degrees of this job. It's going to make you a better person, not just a better physician. I would say, with every patient encounter, to look at it through the patient eyes.

Imagine what it's like to sit in that chair across from you. Imagine what it's like to leave that clinic area, to check out, and get in a car and drive home. Imagine what it's like to care for someone. And if you'd put yourself in that position, it's going to open your entire career to be something more meaningful than you ever thought possible.

[MUSIC PLAYING]

Personal experiences shaped Dr. Shroff and Dr. Shah's approach to patients. But they remain engrossed in the science of clinical research to make important treatment decisions. Both doctors advocate for cancer research funding, particularly, for women oncologists. You can learn more about the research Conquer Cancer supports at conquer.org.

Hearing the experiences of others can help people cope with the challenges cancer brings. Help others find these inspiring stories by leaving a review of the podcast. And subscribe today on iTunes or Google Play to hear every new episode. Thanks for listening to Your Stories-- Conquering Cancer.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.