The Narrow Path
Authors: D P Steensma
Journal: Journal of Clinical Oncology (2001)

Article Tools THE ART OF ONCOLOGY: WHEN THE TUMOR IS NOT THE TARGET Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2001.19.7.2102 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 11283147 The Narrow Path David P. SteensmaxDavid P. SteensmaSearch for articles by this author Charles Von Gunten, MD, PhDxCharles Von GuntenSearch for articles by this author Show More From the Mayo Clinic, Rochester, MN; and the Center for Palliative Studies, San Diego Hospice, San Diego, CA.San Diego Hospice, San Diego, CA https://doi.org/10.1200/JCO.2001.19.7.2102 First Page Full Text PDF Figures and Tables © 2001 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical Oncology EDITORIAL COMMENTARY01042001 I wonder if other oncologists who read Dr Steensma’s essay will experience an uncomfortable moment like I did when I read it. How could it be that we oncologists can feel so unsupported during an episode of nearly unspeakable tragedy and horror? Why do we think we need to figure out, on our own, how to cope with the sequential tragedies that may comprise the practice of oncology? For me, that moment of discomfort was followed first by recognition, then by a more lasting sadness. I recognize both the feeling of being mute in the face of tragedy and also the “hidden curriculum” in medicine to “be tough and suck it up.” The consequences are there for all to see. I am sad when I hear patients and our professional colleagues outside of oncology variably disparage oncologists as cold, impersonal, unfeeling, and cruel. Dr Steensma’s story gives me insight into how this might happen. The overwhelmingly common reason to go into medicine in general, and oncology, in particular, is to be helpful—to make bad things better. Gradually, during the long training process, cynicism and cold detachment may be learned. We may learn that from seeing those around us, and above us, handle difficult situations. We may develop patterns that will protect us from being hurt again. Why don’t we make the nurturing of coping skills in ourselves and our colleagues a priority? Why aren’t we broadly admired for how well we care for those who will ultimately die? Dr Steensma has found some coping strategies for himself. Part of his coping is clearly in writing about his experience. When 265 physicians were first trained to use the Education for Physicians in End-of-Life Care (EPEC) Curriculum,1 the participants chastised us for omitting a discussion of professional self-care from the original draft of the curriculum. To rectify this, an additional session was added regarding how to care for oneself in the face of multiple losses. This EPEC module (the EPEC curriculum is available at http://www.epec.net) is based on the collective wisdom of many individual physicians provided in context with literature on stress, burnout, and professional self-care. Oncologists should be knowledgeable regarding this subject.2,3 REFERENCES1. The EPEC Project: Education for Physicians in End-of-Life Care. Http://www.epec.net. Google Scholar2. Whippen DA, Canellos GP: Burnout syndrome in the practice of oncology: Results of a random survey of 1,000 oncologists. J Clin Oncol 9:: 1916,1991-1920, Link, Google Scholar3. Ramirez AJ, Graham J, Richards MA, et al: Burnout and psychiatric disorder among cancer clinicians. Br J Cancer 71:: 1263,1995-1269, Crossref, Medline, Google Scholar