Cancer is often a devastating diagnosis that has a profound impact on a patient's physical health and emotional, social, and psychological well-being. Cancer diagnosis evokes fear of death or uncertainty leading to overwhelming anxiety in the patient and family. This is shown in the form of shock, disbelief, sadness, anger, or a sense of helplessness due to lack of control over their future. Usually, this is followed by physical challenges the patient faces with the treatment be it surgery or chemotherapy, or radiation. The physical challenges following treatment can be the side effects, pain or a decrease in overall quality of life. The other factors that could be stressful to deal with include the treatment cost and social relations. Cancer treatment is expensive and can be a big financial burden especially if one does not have health coverage. Similarly, the treatment of cancer can be of long duration and can strain even the closest bonds in family and friends be it due to lifestyle disruption or social stigma. Most of these challenges lead the patient to self-isolation and uncertainty.
Professionalism in cancer care is not just about medical expertise, it should also address the physical and psychosocial aspects. Apart from the clinical excellence in cancer care, the doctor should entail compassion and empathy. Most health care providers including specialist doctors and nurses possess the necessary knowledge, skills and experience to diagnose and treat cancer effectively. Most of them abide by evidence-based practice which is crucial for most effective and appropriate care. In addition to this, it is also important for the clinician to understand the patient’s perspectives in various terms. This can be achieved by actively listening to patient's concerns and addressing them with sensitivity and respect. The clinician should respect the patient's autonomy in treatment decisions and preferences and also maintain the patient's privacy and confidentiality at all times. This kind of clear and honest communication with the patient and family is important throughout the treatment journey. Treating all patients with dignity and respect is important regardless of their age, gender, race, ethnicity and socioeconomic status. The clinician must note if the treatment is covered by the insurance company or if it is an out-of-pocket expenditure. A long-term financial planning must be discussed with the patient and family so that the necessary budgeting can be done. It is then depending on the patient’s financial and social background, that the clinician should provide holistic care and not unnecessarily prescribe costly medicines or tests. It is said that a “hungry physician is apt to prescribe more.” The clinician should always think about the financial burden that medical treatment can impose. Few clinicians may have personal financial gains from prescribing costly medicines or unnecessary tests. Ordering more tests or costly medicines can be due to more than one reason. Some clinicians write more tests to protect themselves from potential malpractice claims and avoid lawsuits. However, a few clinicians have a financial motive in writing more tests or medicines to directly increase their income or to get a bonus.
Clinicians should not prioritize financial gain over patient care by prescribing unnecessary tests or drugs. They should not indulge in doing unnecessary procedures solely to increase their revenue. Kickbacks and referrals or other kinds of incentives for serving the patient are like accepting a bribe. The psychology of such clinicians who prioritize financial gain over patient care can be due to greed or materialism which is driven by a strong desire to make money. The lack of ethical principles makes such clinicians succumb to such financial incentives or easy money. Some of them may even justify their actions by rationalizing to the situation over the ethical considerations. Few clinicians advise patients and families that new medicines may work wonders, despite the financial burden that medical treatment can impose, with costs sometimes outweighing health benefits. The patient and family should be empowered with the treatment information, their options and the cost associated with it. It should not be like “treatment snatches away wealth more than it restores health.”
So, what should the patient do?
To be an informed patient, before each appointment one should research their medical condition and the potential treatment options available. After this, if one has concerns about the treatment plan or cost, they should seek a second opinion from another qualified healthcare provider. The patient should always keep the detailed treatment records. If the patient or the family feels that the doctor seems to be in a rush and is dismissive of the concerns then it could be a red flag, it may be time to find a new care provider. The family should be aware that if the doctor is engaged in malpractice or unethical behaviour, they can file a complaint with the relevant regulatory authorities or medical board. For fellow doctors too, it is important to report incompetent or unethical behavior by fellow colleagues. Catching “bad” clinicians can be difficult but taking steps to ensure that the patient receives the highest quality care is important. A few doctors may attempt to evade accountability for malpractice and deaths through manipulative counselling techniques and also falsifying the medical records in events to sign away from families pursuing legal action or even conspiring with other medical professionals to create a false narrative or conceal evidence of malpractice. It is important to seek legal counsel advice if malpractice is suspected.
Many factors influence a doctor's decision-making process which might include the patient's needs, clinical guidelines, and their ethical principles. However, by prioritizing professionalism, the healthcare provider can significantly improve the lives of many cancer patients and their families. A good governance from the hospitals is important in helping patients navigate the challenges of this difficult disease cancer with dignity, hope, and resilience.
Dr. Nagendra Parvataneni, Senior Consultant & Head of the Department Surgical Oncology, KIMS Hospitals, Sec-bad
