When patients want their doctors to heal [PODCAST]

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“I think it’s much more likely that my patients — some of whom are terminal and facing their own mortality; others who are suffering through a multitude of side effects from their cancers or our treatments – my beautiful patients haven’t let cancer compromise that core of humanity that allows them to care deeply about the welfare of another human being, despite what they are living through. They wanted me to heal just as much as I hoped for the same for them.”

Mikkael A. Sekeres is a hematology-oncology physician and author of Drugs and the FDA: Safety, Efficacy, and the Public’s Trust.

He shares his story and discusses his KevinMD article, “When my patients cared for me.”

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Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show we have Mikkael Sekeres. He’s a hematology-oncology physician. He’s the author of the book Drugs and the FDA: Safety, Efficacy, and the Public’s Trust, and he wrote the KevinMD article “When my patients cared for me.” Mikkael, welcome to the show.

Mikkael A. Sekeres: What a privilege it is to be here. Thank you so much.

Kevin Pho: So we’ll get into your article in a little bit, but first off, briefly share your story and journey to where you are.

Mikkael A. Sekeres: When I was in college and applying to medical school, we all remember that process, right? You go and you meet in front of an individual person, or maybe even a committee of people, and they ask you that one question: What are you going to do if you don’t get into medical school? And I think the right answer to that is that you’re going to work slavishly in a lab until the authorities in medicine deign to offer you a position in their vaulted hall. But my answer to that was always, well, I’d just go ahead and be an English professor.

And that has always been my background. My parents were both English majors in college, my dad was a journalist, and writing for us was the family business. So for me, to write is to breathe, and it’s a way that I use for processing the incredible deluge of humanity that we see in medicine. If you imagine, it’s one of the few professions where you really see people from all walks of life. One of the things I always say, and I specialize in leukemia, is that leukemia doesn’t read a tax return and it doesn’t read a political affiliation. So we really see a cross-section of humanity, and it’s a privileged position to be in.

So for me, I’ve been writing, honestly, since the age of six. While I was in medical school I took writing courses, and I journaled through residency and fellowship, and then I started to write essays, first for hematology-oncology journals and medical journals in general, and then specifically for the lay press, which is a much higher bar and actually leaves you feeling much more vulnerable. So that’s what started me on my career of writing. I’ll go back to what I said in the beginning: For me, writing is breathing, but it’s also a way that I feel as if I remain engaged seeing my patients, and I’m able to really be thoughtful in the interactions I have with them.

Kevin Pho: So when it comes to that intersection between medicine and writing, there are so many wonderful physician authors. Give me an example of how your writing has moved the needle for you professionally as a hematology-oncology physician.

Mikkael A. Sekeres: I think one of the reasons it has, and when you say “move the needle,” I love that phrase, because it can be interpreted so many different ways. I think from a humanitarian perspective, it’s moved the needle because it’s brought me even closer to my patients and made me able to empathize with what they’re going through and truly understand their perspective on disease.

The research that I do runs the gamut from translational hematology-oncology and understanding the genetics of some of these myeloid malignancies all the way to quality-of-life decision-making and even improving value of care. So across that spectrum, I think of my patients’ experience with disease, and I have really geared my research to answer that question: What is this like for a patient to go through, and how is it we can make that better? You can define “better” in as many ways as you can say “move the needle.”

It’s also moved the needle for me in the way that I’ve considered writing to not just be therapeutic but actually to be an academic pursuit within medicine. And I think for anyone out there who’s particularly a physician writer, I always keep front and center the fact that what we do is as academic a profession as people who are working in a lab understanding the genetics of disease, to people who are conducting epidemiologic studies. And we have to be careful to guard that professionalism in how we approach, for example, narrative medicine, and make sure that we remind people that it’s just as academic a pursuit as anything else.

Kevin Pho: All right, let’s talk about one of the stories that you wrote on KevinMD. It’s titled “When my patients cared for me.” Now, for those of you who get a chance to read your story, just walk my audience through it and share it today.

Mikkael A. Sekeres: Sure. This is an event that occurred over the summer. I have a clinic full of patients who have a much different background now that I’m in Miami, over the past two years, than they did when I was practicing in Cleveland. I have a lot of patients who are Spanish-speaking only; 60 percent of our population is from Latin America or has family who is from Latin America, another 20 percent are Afro-Caribbean or African American, and I’m in the minority: 20 percent are white. A lot of my patients speak Spanish, and I’m just learning how to speak Spanish. I didn’t come into this with any kind of great background in it, but I’ve really come to appreciate the culture and the diversity of backgrounds. Not everyone who is, quote unquote, Hispanic is the same person or comes from the same background.

This story started when I was seeing a patient who was a Cuban housekeeper who came to Miami during the Mariel boatlift in 1980, as a lot of people did. She’s now in her mid-60s, she speaks Spanish only, and I started to see her on a Zoom meeting. The twist to the story, though, is that she wasn’t the one who was on Zoom. She was actually in my clinic room. I was the one on Zoom, because I had developed COVID.

And this is something a lot of us have gone through in medicine. We have strict policies at work where we don’t, and shouldn’t, come into work when we’ve had COVID and are still testing antigen positive, so we’ve engaged in telemedicine. This happened right before clinic day, and we thought that for my patients, who have to come in to have their blood counts checked and often to receive transfusions, the best course of action was that they should continue to come into my office with my nurse practitioner, and I would see them from my home on Zoom.

What really moved me is that I was actually feeling OK at home by this point. I didn’t have a really bad case of COVID, probably because every time another vaccination opportunity opens up, I grab it, as most of us do. What really moved me was how much she worried about me. And it’s this remarkable phenomenon among our patients. They have an incredibly serious diagnosis. They have a diagnosis of acute leukemia or other bone marrow cancers that will severely truncate their lives. They’re going through chemotherapy. Yet when I become sick, from a common cold to something that’s more serious like COVID, there’s an outpouring of emotion from them. And because I was on Zoom, it was even more dramatic, where it wasn’t just emotional, but they actually assumed the role of the health care provider, and I was the patient.

Kevin Pho: So give us an example of that. Take us into that interaction. How did she do that?

Mikkael A. Sekeres: What she did. I kept mulling this over, and for me, stories always start at a point of tension, and that could be good tension or bad tension, where I want to move backward and forward in time to try to understand where that tension lies and how we can resolve it. So in this case, I’ve thought about this a lot, and I think part of it is that she was the one in the clinic room. She was in a clinic room, sitting in one of our rigid chairs, with the bright lights and the austere interiors that tend to be various shades of white, and with the antiseptic smell. And I was the one who was at home in my usual surroundings, which is sitting at a desk with my bookcase in the background and a window with a tree in the beautiful Florida sunshine.

And what happened was patients at first started to empathize with me, asked how I was feeling, and then started to ask some of the same questions I would ask them during an appointment, and then started to give me advice on how I could get better. And that advice ranged from “Make sure you get lots of sleep, drink lots of fluids, take some aspirin or some other sort of NSAIDs” all the way to recommendations for what I would consider to be folk remedies: “Here’s a vitamin solution that I use. You need to get this specific brand. You need to have some teas.” And it was really marvelous, wonderful.

Kevin Pho: So tell us what happened next.

Mikkael A. Sekeres: So as she was essentially caring for me, and this happened across the span of the day, I had a full clinic, so it was a morning and afternoon session, while I was at home I started to reflect on how it is that my patients, who were so very ill themselves, would have this kind of outreach toward me. And I realized at the end, my patients haven’t let cancer compromise them. They don’t define themselves by their cancer. And I think, more importantly, they haven’t let it affect that core of humanity that allows them to care deeply about the welfare of another human being, despite what they themselves are living through. Kevin, they wanted me to heal just as much as I want them to heal, and it was a beautiful moment when I came to this realization and this even deeper appreciation of the types of people my patients are.

Kevin Pho: So tell me about how interactions like these, and that’s such a poignant interaction that you just described and told the story of, how does that change you in terms of how you interact with patients in the exam room?

Mikkael A. Sekeres: Yeah, I think we go through a lot of waves of this over the course of our training. We go into medical school, Kevin, and I’m sure you did the same as me, for the right reasons. We want to help other people. It sounds almost childlike when you say it out loud, but it’s really true. We are in a rarefied profession, where we have the privilege of being invited into people’s lives when they are at their most vulnerable, and we’re offered the opportunity to try to help them get through that crisis.

Then we go through training, and a lot of times that training objectifies us. We’re asked to adhere to somebody else’s schedule. We have a little choice in the matter; saying no really isn’t an option if you want a career in medicine. There are long hours, and ultimately we’re not really responsible for the patient, and often we’re treated as someone who’s a caregiver as much as the attending staff is. I think that dehumanizes us, and I think it puts us at risk of dehumanizing our patients and objectifying them.

We come out of that as staff members, faculty members, and with that we regain some of our humanity and have this opportunity to relate to our patients like people again. Some of that is influenced when our own family members become sick and we are put into the role of either patient or caregiver of a patient, and we see things from another perspective. But I feel like the opportunity to write, and it doesn’t have to be formal essays that are submitted to journals or the lay press, it’s going to be casual writing, allows us to explore that humanity at an even deeper level and come to understand our patients’ experience.

Kevin Pho: So sometimes we need to hear stories like these to really get to the core of why a lot of us go into medicine in the first place. I’m a primary care internal medicine physician, and as you could imagine, there are a lot of impediments that really obstruct us from that connection that we should have with patients, and I’m sure that you have a lot of impediments too in hematology-oncology. Now, despite all these impediments, the bureaucracy and everything that prevents you from giving the best care you could for patients, how do you maintain that humanity? Because there are so many external forces that intrude on that doctor-patient relationship.

Mikkael A. Sekeres: Boy, that’s a great question. I’ve been reflecting on this recently. We hear a lot about burnout in medicine. A recent report came out that showed that 60 percent of physicians have at least one symptom of burnout, or express that, and a large percentage have more than one. We’ve seen one-third of our workforce in some places leave medicine during COVID, and these aspects are even higher among people who are really on the front lines of taking care of patients with COVID, such as the physicians and nurses who are in the emergency room or in the intensive care unit.

You know, I went through a period of time during my fellowship training where I didn’t see patients anymore. In a hematology-oncology fellowship program, you’re very patient-heavy for the first year and a half. If you also focus on hematology, then you may have a continuity clinic with a handful of patients, but a lot of people really don’t see a lot of patients during the latter part of the year and a half. And I found during that period, when I wasn’t seeing patients, I became depressed. I also found that my research veered off and didn’t really get to the core of answering questions that are important to patients. So for me, it’s revitalizing being able to see patients and remind myself of why I went into this field at the very beginning.

I also try to create an aura during my clinic day. I see patients one day a week as an outpatient, and I attend on service one month a year. During that day, though, I almost treat it like surgeons treat the operating room. That’s my protected space; that’s where I really want to focus on patient care. I try to exclude other things, other parts of my life that we also have to deal with, both administrative parts and some of the annoying parts of our lives, like dealing with electronic medical records. But maintaining that focus for a day a week, treating it as a privileged, special place for me, has kept me reinvigorated.

Kevin Pho: We’re talking to Mikkael Sekeres. He’s a hematology-oncology physician. His KevinMD article is titled “When my patients cared for me.” Mikkael, what are some of your take-home messages that you want to leave with the KevinMD audience?

Mikkael A. Sekeres: There are a couple of them, Kevin. The first is to remember your core humanity, to remember what brought you into medicine, and to not be afraid to be vulnerable and bring you back to that space.

Another part of it, and again I’m going to focus on physician writers, and that is, of course, the people who contribute essays, by definition, to you, is to keep writing. Keep trying. Remember that this is as hard to do as any academic pursuit. I spend just as much time working on essays and then submitting them for publication as I do on some of my scientific articles. And make sure that you don’t let other people define this as a hobby. It’s an academic discipline.

Kevin Pho: Mikkael, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

Mikkael A. Sekeres: Thank you so much for the opportunity to be here, Kevin.

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