ONCOLIGIST-A NEW SPECIES

Oncology Is "Cool"? Who Knew?

Not every doctor is cut out to treat patients with cancer. Picture yourself, biopsy report in hand, giving a patient what is apt to be the worst news of his or her life. Picture the look on the patient's face. Picture doing this 20 or 30 times a day.

Most doctors, understandably, would rather not.

Yet, out of nearly 850,000 active physicians in the United States,^[1] approximately 13,000 of them^[2] -- the number of oncologists, hematologists, and hematologist-oncologists currently in practice here -- see things differently. They don't like delivering awful news any more than other doctors. Nor are they unaffected by the suffering of their patients, with whom they often develop deep personal relationships. They're just as human as anyone else.

And yet, paradoxically, far from being morose and depressed, oncologists are more likely to bubble with enthusiasm for and express joy in what they do. This observation alone suggests that these doctors are cut from a different cloth.

There is no special trait or talent or skill that sets them apart, oncologists are the first to admit. It is rather that traits and skills found in doctors throughout medicine tend to come together in doctors who choose oncology in particular combinations, often for particular reasons, and are shaped and refined in specific ways due to the unique demands of the specialty. For example:

• If they are different from other doctors, oncologists suggest, it's primarily because patients with cancer are different from other patients;

• Their relationships with patients are probably "deeper," "more intense," and "more personal" than is usual among physicians because, oncologists observe, dealing with cancer often necessitates a deeper level of physician engagement;

• Because their patients must make a myriad of decisions during the course of their treatment, oncologists find that they spend considerably more time on patient education, over a sustained period, than is customary in many other specialties;

• Their patient relationships are unusual in that they tend to run in cycles, oncologists reflect, with predictable periods of agreement and others of sharp disagreement;

• The science of oncology is exciting now, with many promising new drugs, but oncologists must temper their enthusiasm with patients, for whom a reprieve of 3 years today vs 8 months a decade ago is generally not a cause for celebration; and

• The nature of their work, oncologists contend, forces them to confront their own fear of death more forthrightly than other doctors may need to in order to cope.

But oncologists say they love what they do. "Some doctors actually find this attractive in the sense of the challenge -- of trying to provide care in a very human fashion," says Nicholas Robert, MD, a breast cancer expert at Virginia Cancer Specialists, a community group of 25 oncologists in Fairfax, Virginia.

In Medscape's 2013 Compensation Report, in which nearly 22,000 physicians took part, 57% of respondents who were oncologists reported that they would choose the same specialty if they had it to do over again, one of the highest percentages of professional satisfaction in the 25 specialties surveyed.

"Exhilarating," "cool," and "fun" are how Robert describes recent advances in understanding the molecular biology of cancer, the procession of promising new therapies now in phase 3 clinical trials or recently approved, and the challenges in caring for patients in whom multiple organs may be affected by their disease.

In his Pulitzer Prize-winning "biography" of cancer, The Emperor of All Maladies, Columbia University oncologist Siddhartha Mukherjee, MD, declares cancer an "ancient monster," "this grotesque and multifaceted illness," and "the defining plague of our generation."^[3] How is battling this ancient monster fun? Who are these specialists to whom you refer patients when you discover a worrisome lump?