View From the Other Side of the Stethoscope

As an internist and cancer survivor, Wendy S. Harpham, MD, FACP, offers a unique perspective on oncology practices.

Friday, January 5, 2018

My New Year’s Resolutions

Resolutions are firm decisions to do—or not do—something from now on. I make resolutions throughout the year, often delicately expressed as, "Dang! I'll never do that again." In contrast to disaster-driven vows, my New Year's resolutions are the result of ritualized reflection that begins days before the downbeat of Auld Lang Syne.

Insights and lessons learned through academic endeavors and personal experiences give rise to new hopes for how I want live my life in the coming year. To help both my professional and personal hopes become reality, I compose a list of New Year's resolutions.

Today, looking over the spanking new list of resolutions taped to the frame of my computer, the three related to my survivorship work catch my eye:

  • Help patients build resilience
  • Help patients choose healing hopes
  • Help patients celebrate today

A year ago, those resolutions would have sounded humdrum. Not today. Exploring those topics this past year opened my eyes to their power to help patients get good care and live as fully as possible. Here's how I expect to use those resolutions to serve my life mission through writing, speaking, and one-on-one conversations. I'm convinced they would have served that same mission while I was practicing medicine.

Resolution #1: Help patients build resilience

It's ridiculous that no ICD codes or board questions address patients' resilience. Patients need resilience—the ability to recover from difficulties—to endure cancer treatments and enjoy life despite unwanted changes. I can help patients build resilience by guiding and supporting their efforts to…

  • Accept and adjust to things they cannot change. Acceptance helps them avoid wasting time and energy striving for something that's never going to happen. Adjustment makes life easier. I can encourage patients to take advantage of the services of counselors, allied health professionals, and resources that facilitate patients' acceptance and adjustment.
  • Develop realistic expectations about the pace and difficulty of recovery. Such expectations help patients avoid disappointment or despair. I can guide them to facts about how to facilitate a smooth recovery. If indicated, I can suggest they ask about rehabilitation services.
  • Address modifiable factors that deplete resilience. I can encourage patients to talk candidly with their physicians about signs and symptoms, including problems with sleep, nutrition, mobility, and mood, as well as about the various stresses in their life.
  • Take steps to build resilience. Survivorship depletes resilience. I can encourage patients to offset some of that depletion by seeking out inspiring stories and aphorisms, as well as carving out time for relationships and activities that fill their soul.

Resolution #2: Help patients choose healing hopes

Hope matters. Not just any hope, but healing hope, namely hope that motivates patients to proper action when they can do something to increase the chance of the desired outcome. Healing hope also helps patients wait while they are doing all they can—and when there's nothing they can do. I can foster patients' efforts to choose healing hope by encouraging them to…

  • Obtain information about the possible outcomes: the best, worst, and most common outcomes—and the likelihood of each.
  • Focus on their hope of outcomes under their control, such as hope to make wise decisions, comply with therapies, optimize behavior (sleep, nutrition, exercise), repair a fractured relationship, find some humor in a tough situation. Patients can maintain hope of outcomes beyond their control, too, but just let those hopes drift into the background.
  • Focus on short-term hopes, such as getting through the next round of tests or treatments, or even just getting through the day. It's fine to think about longer-term hopes such as hope for remission or cure, unless doing so exacerbates anxiety.
  • Periodically reassess their hopes. If certain hopes are no longer serving patients well (or have become impossible to fulfill), letting go of them and finding new hopes fosters healing.
  • Take steps to nourish their hopes, such as reading success stories, surrounding themselves with inspirational messages, visiting with people who lift their spirits and, when possible, avoiding people who drag them down.

Resolution #3: Help patients celebrate today

The medical aspects of cancer care often threaten to consume patients' attention, especially during doctor visits. I can encourage patients to celebrate the small victories, such as a procedure that goes well or an encouraging test result. Celebrations acknowledge patients' accomplishments, help build patients' confidence, give meaning to the hardships, and strengthen the clinician-patient bond. I can encourage patients to find simple ways to celebrate life each day. Doing so sends the messages…

  • Every day is a gift.
  • It is possible to find some joy in tough times.
  • We expect them to find some moments of joy.
  • Joy requires effort.

Finally, I can encourage patients to share with their health care team how they celebrate between office visits. Doing so helps patients feel their clinicians see them as people, not "cases." Personal stories help the health care team understand what patients value, which enables them to personalize their care. Patients' photos and stories of celebrating can be precious gifts to the health care team, too, linking all their hard work to moments of joy.

Throughout the year, my survivorship work enables me to know both the fragility and the hopes of life, and with that knowledge to live most fully. To help me practice what I preach, I added three New Year's resolutions I believe can help my own health and happiness as a healer:

  • Build my resilience every day.
  • Choose healing hopes by asking myself every morning, "What am I hoping for today? How will I nourish that hope?"
  • Find something or some way to celebrate each day, whether by wearing my favorite colors, sharing a joke, or spending time with someone or doing something that brings me joy.

With respect and gratitude for your work, I wish you a healthy and happy New Year.