Changes in the Practice of Hope

By Doug Magill

“We did find cancer in there.”

The words seemed to echo and then rippled into tears down my face.  The urologist I had been referred to had reviewed my biopsy results and the “in there” was my prostate.  He gave me a little pamphlet that explained options for treatment.  It basically indicated surgery was the best choice.  After all, that’s what he did.

I was terrified of the surgery – the potential for incontinence and impotence.  I was just past 50, and though my father had prostate cancer, he was 78 when diagnosed.  I felt cheated; as if my ability to be a man had been given an immediate expiration date.

I emailed the urologist, trying to get a sense that he was interested in me, and would do the best he could to retain my ability to function.  He was noncommittal, and I don’t think he understood that I was looking for hope – someone to take care of me and help me have a life, not just perform a procedure.

In desperation I went to Sloan-Kettering in New York, seeking answers.

The specialist I met with there was a urological oncologist of Pakistani descent.  He was from Vancouver, and had come to Sloan-Kettering to practice medicine, as the socialist monstrosity of Canadian health care did not allow him to do so.  His desire was to work together with patients on their treatment, not be a technician in a system that didn’t value the curative power of the physician-patient relationship.

He was familiar with my case, and was focused and thoughtful during our appointment.  He explained my test results as he diagrammed my prostate, describing the approach that would be taken as my cancer was all on one side.  The surgery would “go wide” – taking not only the prostate but also the tissue and nerves on the side where the cancer was.  Clarifying that this would increase the likelihood of impotence, he seemed offended that my local urologist had not explained this to me.  He could do a nerve graft to replace the nerve to be removed which might help with impotence, but the chances weren’t great.

Because my cancer had been caught early, he advised that I was a good candidate for other treatments which would not have the side effects I feared from surgery.  We discussed my mood and outlook, and the possibility of diet contributing to my cancer.  As we finished, I was given numbers for other specialists and as I prepared to leave he squeezed my shoulder and assured me that I had lots of life left.

His handshake was firm, and his concern seemed heartfelt.

I realized that I needed to do a lot more research on different methods of treating my cancer, and that I had something to hope for.  That kind and gentle man helped me understand what he really meant about practicing medicine.

Today, as our government attempts to dramatically change the way that medical care is paid for, the effects will include drastic changes in its delivery.  I wonder if the term “practicing medicine” will become obsolete, as it will be considered an anachronism by the progressive technocrats and functionaries of a bureaucracy that will dictate policies and procedures with an eye towards managing costs, not care.

Peter Orszag, the former Director of the Office of Management and Budget acknowledged in testimony to Congress that the Independent Payment Advisory Board, instituted by the new legislation, will have the responsibility to set fees, and effectively ration health care.  And access to physicians.

The bill that has been passed includes other provisions that will limit the time doctors can spend with patients and affect the kind of doctors available, and we will end up having to import additional physicians from other countries, as the British do.  Even that will be insufficient, and we won’t get the best, like the urologist from Vancouver.  For, like him, top-notch doctors want to practice medicine and not have treatments to be offered patients dictated to them.

Saint Augustine understood that patience is the companion to wisdom, and we are now committing our country to a system whereby doctors will not have time for patience, let alone the chance to impart wisdom.

Will there be time to spend with a caring physician who wants you to understand your disease and what to do about it?  Will we be able to attract doctors like the one I was fortunate to see, and will they be able to lay hands on and truly treat patients who are seeking answers?  And most of all, will they be able to truly practice medicine where the first and best treatment is hope?

Doug Magill is a cancer survivor, freelance writer and voice-over talent in Solon.  He can be reached at


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