Patient-Doctor attachment and survivorship management

At MD Anderson Cancer Center, where I receive my treatment (and where I work) we have a Survivorship Clinic. Many cancer centers do. Patients are transitioned to this clinic after their active therapy and follow up is complete, and they are in a stable, no-evidence of disease state. They are survivors.

This makes a lot of sense: once a cancer patient has completed active treatment plus some months or even years of active follow up, they no longer need the level of attention they did, and specifically they don’t need the attention of an oncologist, who specializes in the complexities of treating active disease. Shifting their care to a Survivorship Clinic allows the oncologist to focus on what they are best at – patients in active therapy. Also, patients at this survivorship stage may be focused on issues related more to side effects of therapy that can be handled best by a team specializing in these issues – think nutrition, neuropathy, cognitive issues, fatigue and more.

So this transition makes complete sense from the point of view of the patient, the doctor, the system and even the quality of care. It only leaves on thing out: the nature of the patient-doctor relationship. When recently discussing this issue with some colleagues who are expert in the psychology of medicine, one sent me a paper to read: “The Physician: A Secure Base” by Gerretsen and Myers (2008). This paper summarized what has certainly been my personal experience, and that of my wife and also other patients I have talked with: patients attach to their physicians in a way not entirely dissimilar to the way children attach to their parents. As a result, the lack of availability of the physician can induce anxiety in the patient.

Like a parent to an infant, your doctor is a knowledgeable guide to a scary unexplored world and a figure of authority who makes (or at least guides) decisions that affect your survival. I am not saying that patients confuse their doctors with their parents, but perhaps the patient-doctor relationship evokes echoes of the child-parent relationship. Gerretsen and Myers suggest that these parallels are meaningful, and cite data showing that when physician availability was directly addressed, this could benefit the patient – just knowing that they are there has value, again like parents.

My time for transition to the Survivorship Clinic has not yet come – but I to confess that I am not looking forward to it. When it does come I hope that my onbcologist will emphasize that, should I need her again down the road, she will be available. That would be very reassuring.


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