To my oncologist: You certainly were pleasant and compassionate. You also tended to minimize the gravity of the situation when my disease progressed. I know you’re not psychic, but when things are going badly, don’t be afraid to tell me you’re worried.

I see these tragedies unfold so often it has become routine for me now, yet don’t think that your life was less precious, that your death is less grievous, just because you killed yourself with cigarettes. It is not too late to change your future—listen to me!

The reality is that new biological agents are often priced like a Ferrari, and patients who are covered under a pharmacy benefit are required to fork over not a fixed copay but a percentage of the pill’s cost, each and every month ‘til eternity or death, whichever comes first.

Much study has been done on how to promote the most important attribute physicians must have in order to fulfill their sworn duty: that of professionalism. For practicing physicians such frustrations as the insurance bureaucracy and the pressure to generate visits can erode that duty.

As I walked into my office last Monday I found my nurses giving me a peculiar look, one that I usually reserve for incidents like watching someone back into another’s car. The explanation for their solicitude was soon revealed by a stack of charts lying on my desk. During my weekend off, seven of our patients died.

It has been a year since Congress passed the Affordable Food Act, which mandates that all Americans have adequate insurance for the purchase of groceries. Needless to say private industry, always willing to fill a new need, has answered the call.

Would it not be advantageous for people fighting what I call the “vile coward” to take a break from its ugly face? With nothing but the best intentions in mind, I hereby proclaim that all patients have permission to take a vacation from cancer, to schedule a time where cancer is not allowed in the door.

I confess that I have never taken chemotherapy. Strictly speaking this disqualifies me from commenting any further, so I should sign off now. If, however, you don’t mind hearing from one who has administered chemotherapy by the thousands and can bear witness to its effects, then please read on.

Of all the sad pronouncements that oncologists deliver, this may be the one that stings the most. If you were expecting hope from your doctor, how would you react to these words? Would you sit with quiet disbelief, or storm out of the office?

All those who walk through your doorway become your responsibility, at least until you either cure them, satisfy them, or in the rare case of incorrigibles, banish them. Opening our office to all comers is part of every doctor's commitment to the sick, and the faster we accept this, the smoother our day will proceed. Sometimes, though, it ain’t easy.

The end of another year usually inspires us to interesting if not profound reflections, but in my case I am just trying to remember any rainbows of wisdom that appeared to me during 2011. Those who care for cancer patients cannot help but learn new insights about life and death, and since aphorisms are valuable only if spread, why not share a few?

As insurers, clinicians and the U.S. government attempt to slow the increasing rise of health care costs, many experts have identified the tool entitled “clinical pathways” as a solution. Oncologists who adhere to such pathways are thought to improve patient care and reduce expenses.

We are seeing a revolution in cancer care in this country, not just due to advances in chemotherapy and biological therapy, but also in how we communicate and connect with our patients.

I believe cancer doctors have a duty to be accessible to patients as much as possible. Taking treatment for cancer is to say the least an intense experience, sometimes an ordeal, and oncologists must be diligent in keeping everyone up to date on test results, logistics, complications, on good news as well as bad.