symptoms and the doc

this morning i woke up and -- for no apparent reason -- had an insight: the cancer doc is not interested in my symptoms and side-effects... per se.

per se? is that right? i mean, the cancer doc is not interested in my symptoms and side-effects, not *for themselves*. not even for the picture it provides of how i am feeling.

the cancer doc is only interested in my symptoms & side-effects so that she can adjust my treatment.

for example: she does ask if i have nausea. (which i now understand to mean, did i vomit?) her interest is, if i have nausea she will suggest an anti-nausea drug. how do i feel about being sick? that is barely relevant -- unless i feel sick enough to want to take an anti-nausea drug. when i say that i am managing mild nausea by regular snacking (and prunes) she is not really interested.

each week my white blood cells are counted. when the count dropped close to zero, the doc did not offer advice on avoiding disease. her interest is in treatment: she cancelled that day's chemo. admittedly i was with deb, who clearly understood the perils of a low white cell count.

when the doc asked if i had tingling in my toes or fingers, she wanted to know if my body is coping, or should my treatment be adjusted. when i said that the tingling of my feet was slightly worse -- but not painful, not affecting my balance -- no further interest. (well, she was briefly interested to hear that i had had tingling for quite a few months. i had already told her that, told her three or four times. she had not heard, she is not a good listener.)

very old insight: the cancer doc is not a good listener.

new insight: she hears responses to her own questions. she has trouble hearing things that i say that are not in response to her questions. unless i trigger a standard, "we can change the treatment" response. eg if i say i am nauseous.

and: if my answers do not indicate any reason to change my treatment, her interest quickly fades.

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don't get me wrong, this is not a problem. if, for example, i had been seriously worried about the tingling feet, i would have shouted louder.

what it is, is a new understanding. perhaps what i say really is being ignored -- but not everything, not entirely. the doc is hearing what i say (most of it). she will only respond when there is a need (or an opportunity) to change my treatment. her basic assumption is, that the treatment is working. her interest in my side-effects and symptoms is, to know when the treatment is not working. then to adjust treatment accordingly.

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every three months or so, after each mri scan, i like to visit my gp. i justify the visits by such exciting procedures as having a wart removed, wax flushed out of my ears, listening to my heart beat just in case... mostly, though, i talk and she listens. sympathetically. as though she is hearing what i am saying.

my cancer doc manages my cancer treatment. i am happy to trust her with my life, though i now realise that my treatment -- and my life-- is the practical limit of her interest. my gp has nothing whatsoever to do with my cancer treatment. yet she *listens* to what i am saying. it is a very positive experience to talk with a doctor who is interested in more than the only disease that affects me.

i see my cancer doc on a very regular basis, especially in times of regular chemo treatment. i make regular visits to my gp -- though my non-cancer health is as good as ever. deb wonders why i bother.

i knew that gp visits were worthwhile, certainly to my general happiness. and now i have an understanding of why. it's complementary medicine: one doctor treats the cancer, the other treats the patient.

====    Dr Nick Lethbridge  /  Consulting Dexitroboper
Agamedes Consulting / Problems? Solved.
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"If It Ain't Broke, Break It" … Meat Loaf
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dying for you to read my blog: notdotdeaddotyet.blogspot.com.au :-)
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