We Give Treat
By Michael J. Katin, MD
History repeats itself to the point of becoming more redundant than most
of the thoughts in these columns, but yet another example is that many physicians
entering residencies in radiation oncology are now coming from diverse backgrounds
rather than going directly into this specialty from medical school and internship.
Twenty years ago this same pattern could be observed, but for a totally
different reason. Today the reason most residents have had previous life
experiences (graduate work in basic science, surgical residency, President
Protempore of the Senate) is that with 50-100 applicants for each residency
position, it is critical to have some distinction to stand out from the
2002 column). Twenty years ago many of the physicians who applied to
radiation oncology residencies had wandered in to a specialty that was a
mystery to most of the rest of the medical community. Most other physicians
didn't have the slightest idea what we did, and when they started to even
come close to understanding, we'd change the terminology.
Applicants came to radiation oncology with varying expectations, but all
seeking to escape the tyranny
of their former specialties. Just as the United States developed its unique
culture from the contributions of immigrant populations, so did the specialty
of radiation oncology change based on this input. No longer was it based
heavily on hardware, but due to the influence of those of internal medicine
specialty backgrounds, the emphasis was now on evaluation of the patient
as an entity. Were it not for stabilization by radiation oncologists of
extraction, the work up and contemplation of the patient soon would
have exceeded the length of treatment, if, indeed, treatment would have
It was in this environment that my approach toward our specialty was nurtured,and
when I first went into practice I learned from many of the physicians in
the community that this was considerably different from their experiences
with radiation oncologists in the hospital settings in which they had practiced
prior to relocating to Florida. One of them very vividly remembered the
radiation oncologist in his hospital whose approach was directly down to
business, usually seeing the patient and starting treatment within 2 minutes.
The discussion with the patient and family and the informed consent would
usually consist of three words: "We give treat." This is definitely not
to place any criticism on the syntax,
since, I assure you, after four months of intensive study of this persons's
native language I would be fortunate to be able to inquire about the whereabouts
of the nearest bathroom in time to still need to use it. The point is that
there was the logical conclusion that the patient had come to the radiation
therapy department to receive treatment, and there was no reason to not
just go ahead with it.
This seemed somewhat barbaric,
since it had now become mandatory to double and triple check everything
that the referring physicians had already done, to make sure the patient
and all first- through third-degree relatives understood all the ramifications
and alternatives, and then to give out literature and access to support
services prior to a final decision. It turned out, of course, that the vast
majority of patients who came in to see you had already been thoroughly
worked up and screened and if they weren't interested in receiving treatment
they wouldn't have been there in the first place. The patients who actually
needed this thorough evaluation and discussion were those who never made
it to you at all (a conundrum).
I learned as years went on that this legendary radiation oncologist from
"up North" was so far ahead of us he could no longer be seen by the Hubble
telescope. It seemed impossible that we could ever return to those days.
There are still many prominent practitioners in our field who would continue
to support a very compulsive
and comprehensive approach to the patient, for fear of ever being accused
of being "just a technician." In other words, if the surgeon has already
decided a patient needs treatment and we agree with the surgeon, are we
not just carrying out his or her order? No matter what, we'll never be just
technicians, if, for no other reason, it wouldn't be possible. I know that
if I ever tried to work a 2004-era linear accelerator (e.g., the Gladiator
X15-3000B) with multileaf collimators, respiratory gating, and electronic
portal imaging, the result would be my destroying myself and all life forms
within 100 yards.
Fortunately, the philosophy of patient care is now going full
circle, and we may be able to get out of the mindset that we might be
somebody else's decision, whereas in fact we're probably doing the right
thing for the patient. One of the most frustrating conditions to treat is
anorexia nervosa, making most of the diseases we face seem straightforward.
Patients are usually subjected to extensive analysis, family discussions,
and support services. There is now an approach to this dreaded condition,
method, that is getting excellent results. The patients are forced to
This is considered a revolutionary approach, and, in our current era,
this may be the case. If this type of therapy spreads to other problems,
we can envision alcoholics being encouraged not to drink alcohol, school
dropouts forced to go to class, and Britney Spears to avoid wedding chapels.
Patients with heart disease need to get stress
tests and intervention, and patients with cancer need to get appropriate
chemotherapy and radiation therapy. It doesn't get any easier than that.
You go eat.
We give treat.
The author thanks Dr. Lawrence Seidenstein
for his insight and inspiration