“What’s this, Carla? I’ve been your patient since 8 January and you’re just leaving me? You can’t just dump me with another doctor like that! I’m really, really upset.” It’s 2005 and my doctor, Carla Hollak, is changing jobs within the AMC academic hospital. She won’t be seeing or treating patients anymore. Over these past three months, I’ve grown really fond of her. She’s a good doctor, she’s empathic and communicates in a way I can understand and relate to. I’m attached to her. “Peter, I’m sorry. I’m moving on and I can’t take you with me as a patient – impossible. But I’ve taken good care of who I’m leaving you to. You are not someone I can hand over to just any doctor. I asked Marie José Kersten to be your doctor, and she said yes. One thing I’m sure of: if I had your illness, I’d choose her to be my doctor. And I would have a choice to make.’ That’s what swung me. This was so wonderfully involved, personal and honest. I gave in and became Marie José’s patient. I bought Carla a goodbye present: Fantastic Voyage by Isaac Asimov. I was embarking on a new, very special voyage with another skipper at the helm. I could be certain of that.
Cancer patients and their doctors have special, very close ties. After all, you weren’t admitted to the hospital for smelly feet. When you talk to your doctor, it’s about something very real. Chances of survival. What to do? How much time have I got left? All questions that touch the very essence of life, and that you discuss with someone you trust implicitly. Both the patient and his doctor are aware of this – and so are those around them. Such basic trust is a sine qua non for the succesful treatment of cancer. It means that decisions are taken by patients and their doctors in mutual confidence and in a state of calm. Only then will things go right.
Nevertheless, there are still hospitals where you see the ‘duty doctor’. “Who’s your doctor, Erik?” I asked a very sick patient in February. “Well, that’s not so easy to say, Peter. I believe its doctor Hendriks. Yes, Hendriks’s on duty.” Erik was made visibly uncomfortable by my question, and even more so by his own answer. He wanted a doctor for himself. One he kept no secrets from. One he could share the inspiring aspects of his treatment and of his life with. His fears, too. Fear of dying. Fear of leaving his loved ones behind. Those are things you need to share with your doctor, and Erik couldn’t. Of course he couldn’t – not with ten different doctors. Those are things you share with your ‘own’ doctor. But no, in Erik’s hospital it was shifts that counted most, not patients.
I’m naive, and glad of it. I thought it was normal to have such a good doctor, who takes care of everything and who means everything to you inside the hospital. But no, it is one of the reasons why the AMC does such an excellent job. Why Carla and Marie José do such excellent jobs. Patients should not have to rely on a ‘duty doctor’. Patients ought to have a doctor they live with. Whom they may grow to love. That is what makes a patient do better.
Yet this is also where the patient’s own responsibility begins: Don’t accept being allocated to just any doctor. Insist on being assigned to your ‘own’ doctor or move your business elsewhere. Vote with your feet while you have them. The ‘duty doctor’ is an obsolete, 20th century concept. Duty doctors are there for the sake of the hospital, not the patient. If patients leave hospitals that have them, things will change. Not if they surrender and accept.
Patients first! Patients make the difference!