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Touching For Sure, But Not Always

Usually, but not always, when I show for my scheduled post-chemotherapy/post-scan appointment with my oncologist, I am physically examined (touching, feeling). Recently, due to some enhanced computer and facility upgrades, I was shown the actual scans, digitized. However, on more than one occasion over the last 18 months or so, after we discussed the results of my most recent CT Scan – and lab work, no physical exam was performed. Apparently, as I later learned, the good results from my scan sort of trumps any need to feel for physical manifestations. Meaning, that if the scan shows no tumor growth or movement, it stands to reason – medically speaking, that corollary-type symptoms/indications/abnormalities would not occur/be present. To simplify even more, there’s no need for a “pre-operative grope,” to quote Dr. Hawkeye Pierce from an episode of M*ASH, if the diagnostic test shows there’s nothing to “grope.”

On balance then, the doctor’s not examining me is good news, generally, presumably; at least that’s how he explained it to me. It’s a professional version of “Why bother?” There’s nothing to see so he doesn’t have to take a look. I can live with that. Still, I remember the first appointment I had with my oncologist when he didn’t examine me (he always asks questions though); before I sort of realized that I hadn’t been examined, I was already in my car driving home. I said aloud to my wife, Dina: “He didn’t even examine me!” I felt cheated somehow, as if I didn’t get my co-pay’s worth. I called my nurse the next day to complain and express my curiosity/anxiety about why it was that my oncologist had not touched/tested me for any physical reactions/signs as he had on all previous appointments.

My doctor did not call back if I recall, but I believe my nurse did, with some tepid reassurance. However, on my next appointment with my oncologist, we discussed the reason why I hadn’t been examined during the previous appointment. He said there is a debate within the medical profession about this very subject. If the scans are encouraging and show no appreciable tumor growth and/or movement, the patient’s body will likely not exhibit any signs to the contrary. Ergo, physically examining the patient is sort of redundant. However, my concern that something wasn’t done to me (physically examined by my doctor) is not uncommon, my doctor said, and causes patients to have a not-unexpected reaction: skepticism. The perception by us patients is that the doctors are not in fact doing everything they’re supposed to be doing, “Hippocratically” speaking. The doctors might know better, and know the facts, but when dealing with us patients, there are feelings to consider. And if the patient’s feelings are not considered during this fairly intimate doctor-patient relationship, then the facts, clear as they may be, may fall on deaf ears. This is the quandary – as it was explained to me; examine a patient who you know (from their most recent diagnostic scan) is not experiencing any negative reactions (to their disease) or, don’t examine the patient and cause a negative emotional reaction by not physically examining them. And as any of us terminal patients will attest, there’s a fine line to be straddled between positive and negative thoughts and interpretations and how they affect the patient. Maybe, reassuring the patient might be more important than following protocol?

As much as I want to be a patient patient, the longer I survive, the more impatient and paranoid I’m becoming. I want to enjoy the good news, really I do, but sometimes I can’t. Damn cancer.