I read with dismay statements made by and
attributed to Winfield Boerckel, CSW, a Cancer Care, Inc. information support
systems coordinator and a lung cancer support group facilitator, in the March
2001 issue of ONI ("Relieving the Symptoms of Lung Cancer and
The article states that Mr. Boerckel "pointed out that the
physician is generally not the right person from whom to seek emotional
support." In a quote, Mr. Boerckel said: "It is important to see
physicians as being there to provide information and treatment…
Communications with the physician should focus on getting information about
disease and treatment."
It is quite unfortunate that Mr. Boerckel does not view the
physician as the "right person" to provide emotional support to the
patient. Who then is the right person, if not the physician? While a
multidisciplinary approach to patient care should be the norm for cancer
patients, the role of the physician must always include attending to the
emotional aspects of patient care.
A physician may choose with the patient and family to explore
ways of obtaining additional emotional support, psychosocial evaluation,
psychiatric intervention, etc. Referrals may be made to mental health
professionals. Similarly, patients and families may readily identify the need
for additional help, through individual, family, or group psychotherapy or
All physicians understand the importance of the emotional
aspects of cancer and its treatment. Certainly, we need better and more
consistent screening of all cancer patients to identify distress. We know, for
example, that it is often very difficult to separate out the vegetative
symptoms of depression from the side effects of various oncologic treatments.
Screening instruments such as the NCCN Distress Thermometer
will allow busy clinicians to routinely identify those patients who are having
emotional problems and then triage those patients to the appropriate level of
At the University of Michigan Comprehensive Cancer Center, we
try to identify patient and family distress and work in a cooperative,
multidisciplinary manner to address both physical and emotional needs.
While patients and families may get additional support and
psychosocial evaluation and care, the physician is always listening for and
attending to the emotional needs of the patient. Although cancer centers are
busy and there are time limitations, focusing on the psychosocial issues of
cancer is central to quality care.
Physicians should not delegate the emotional aspects of care to
other clinicians, as Mr. Boerckel suggests. Certainly, other professionals can
and should help in the multidisciplinary approach to patient care. The bond,
however, between a doctor and patient goes beyond the technical aspects of
chemotherapy, radiotherapy, surgery, etc. It is a critical element of patient
care and always includes the emotional care of the patient.
1. Holland J, Benedetti C, Breitbart W, et al: NCCN Practice
Guidelines for the Management of Psychosocial Distress. Oncology 13:5A:113-147,
2. Tasman A, Riba M, Silk K (eds): The Doctor-Patient
Relationship in Pharmacotherapy: Improving Treatment Effectiveness. New York,
NY, Guilford Publications, 2000.