By Philip A. Salem, MD
My journey in cancer medicine started in June 1968, when I traveled from Lebanon to New York to begin my fellowship in medical oncology at Memorial Sloan Kettering Cancer Center. Since then, and on a daily basis, I have been actively engaged in the treatment of patients with cancer and in cancer research.
After completing my training in the United States, I returned to Lebanon in 1971 to serve on the faculty of the American University of Beirut Medical Center. In January 1987, I returned to the United States and joined the faculty of MD Anderson Cancer Center in Houston. In 1991, I established Salem Oncology Center in Houston and remain its President.
Looking back at this long journey, which has shaped my life and enriched it, I cannot but thank the Lord immensely for giving me this unique opportunity. It has been a privilege and a great honor to serve patients with cancer and to be part of the scientific revolution that has led to major advances in the prevention and treatment of this disease. It is difficult to speak about all the lessons I have learned during this journey, but here are some important ones.
Knowledge Alone Is Not Enough
Patients with cancer need to be embraced with love and compassion. They need caring beyond medicine. They need a lot of time to talk to their doctors about their fears, anxiety, concerns, and, above all, the fear of losing their dignity. I believe physicians today have very little time to talk to patients, often immersed in bureaucratic requirements. The focus for many doctors has shifted from caring for patients to protecting themselves against litigation. Also, their time is consumed with compliance to government rules and insurance requirements.
“Patients with cancer need to be embraced with love and compassion. They need caring beyond medicine.”
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Without hope, it is impossible for patients to fight and persevere in the struggle to regain their lives. There is no controversy as to the right of patients to know the truth. However, I believe that telling the truth is a sophisticated art and that the so-called truth should never be delivered at the expense of hope. There is always hope. I have seen many patients who were told by the best cancer centers in America that their disease was terminal and there was no hope; They defied the odds and lived for many years in good health.
Education is power, particularly in oncology. It can be the power that helps defeat death. Not only do patients with cancer need to know the truth, they need to have comprehensive education about their disease, as this is crucial in helping them conquer it. I have come to believe that educating patients is an integral component of treatment.
A major key to success in cancer treatment is perseverance. The journey to defeat cancer is brutal and long. Therefore, a patient’s perseverance is of the utmost importance. However, I have learned from experience that perseverance from physicians is even more important than perseverance from patients. Treatment may be ineffective once, twice, or three times, but both the doctor and the patient should persevere. Only those who persevere can achieve results. A doctor may not know what he is capable of achieving unless he perseveres. Many patients die prematurely because either they or their doctor(s) abandoned hope.
The Meaning of Failure
I have learned that failure is the same road that takes you to success. One cannot achieve success without going through failure. Failure should not be an excuse to retreat; it should be an opportunity to learn, refuel, and go forward. Those who fear failure cannot succeed. Failure is the best teacher you can have if you are ready to learn from it—it teaches you humility and reminds you how limited human knowledge can be.
The more experience I gain, the more I appreciate teamwork in the treatment of cancer. To give your patients the best care, you, as a doctor, need to leave your ego at home before you come to work. You should be humble enough to listen and respect others’ opinions and should be able to work with others. Teamwork is not only important for patient care, but it is also important for the doctor, as it can be educational. I have rarely attended a team discussion without learning something new.
However, it is important to emphasize that a team is not a team unless it has a leader. The treating physician must listen to all consultants and team members, but eventually, he is the one who should make the final decisions. I have learned that humility is a great virtue and that arrogance is a major obstruction to learning and making progress.
A doctor may fail many times, but he only becomes a failure when he succumbs to it. One should always focus on the light at the end of the tunnel and should have the courage to move forward, toward that light. A doctor should always focus on what is best for his patients and give them what he thinks is the best treatment. He should not be bound by what is considered standard care; he should be bound by what is best for patients. The courage to dare is an essential component of success.
Health Care Is a Human Rights Issue
A country’s biggest shame is to have a citizen who cannot receive medical treatment because he cannot afford it financially. The right to maintain life is the most sacred right and should be the most important human right. I cannot think of another human right that could supersede the right to life. Every other human right fades in comparison.
The Current Assault on Medicine
The greatest achievement of the United States is American medicine. People from all over the world come to the United States to receive the best treatment. However, there are forces in America (governmental, insurance, and legal) that constitute a major assault on the essence of medicine. Doctors should rise to the challenge and should not let this assault succeed—they should not allow American medicine to be destroyed.
There Is No Job More Noble
There is no job that can elevate you as much as that of giving yourself and your life to helping others. I have also learned that a job is as noble as the person who performs it.
I thought the lessons mentioned here could be of help, particularly to young doctors who have just started their professional journey. Needless to say, these lessons are not the only ones I have learned. For more, I would like to refer you to my book, Defeating Cancer: Knowledge Alone Is Not Enough. My book was published when I completed 50 years in cancer medicine. It is a message to all doctors who treat patients with cancer and a message to all patients with cancer.
In conclusion, I would like to say that my journey has elevated me and has given significant meaning to my life. If I were to go back in time to June 1968, I would not change a thing. I have nothing but thankfulness and gratitude for all those who have guided and helped me become the person I am now. No one can make it alone.
* Dr. Salem is Director Emeritus of Cancer Research at Baylor/St. Luke’s Episcopal Hospital and President of Salem Oncology Center, both in Houston.
DISCLOSURE: Dr. Salem reported no conflicts of interest.
Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO or The ASCO Post.