Does Being a Psychiatrist Affect Response to Cancer?

Though hardly surprising, psychiatrists are no different from other people when it comes to coping with the reality of being diagnosed with cancer, according to panelists at APA's 2006 annual meeting in May in Toronto.

“Denial is alive and well and working in psychiatrists,” said Madelaine Wohlreich, M.D., who spoke from personal experience.

Wohlreich, a medical advisor at Eli Lilly and Co., found a lump in her breast in January 2005. For six months prior to her discovery, she had experienced pain that she attributed to a bra not fitting well.

She found her denial “particularly striking” given the fact that her mother had breast cancer and had a mastectomy when Wohlreich was 11. In fact, she decided to become a physician in part because of the stressful medical problems experienced by her mother and other family members, she said.

As an adult, Wohlreich was diagnosed with breast cancer soon after finding the lump and experienced “terror, an absolute sense of the world collapsing, as anyone would,” she noted.

Waiting to receive her diagnosis was perhaps the most difficult time for her. “Foremost, I had fear that I was facing my own death,” during this time.

Wohlreich noted that being a physician as well as a patient can be a double-edged sword. Her work in the pharmaceutical industry ensured that she had good health benefits, and her career as a psychiatrist helped her sift through medical literature with more ease than someone without a medical degree.

During the first few days after the diagnosis, Wohlreich spent much of her time in front of the computer searching for information on breast cancer treatment and prognosis. However, she said, “the disadvantage of being a physician and facing this diagnosis is that you are more aware than others about the potential for negative outcomes. I've seen patients dying of cancer and knew too much about what I might be facing in the future.”

Another disadvantage of her status as a physician was that she could not“ assign magical powers to my treatment team as many other patients with cancer do,” she said, being aware that luck would play a role in the course of her illness—not just the medical skills of her treatment team.

“Describing yourself as a physician to members or your treatment team does grant some privileges and respect,” Wohlreich said, “but sometimes I felt the need to say, `please talk to me now as a patient and not a physician because I'm feeling overwhelmed.'”

She found many positive ways to cope with the diagnosis and treatment that she endured by becoming involved with real-life and Internet breast cancer support groups, through which she found women with whom she had much in common.

She gained a number of close friends in the process but noted, “I'm well aware that some of them with less-positive prognoses will likely succumb to this illness.”

She also took a course titled “Look Good.. .Feel Better,” offered to women undergoing cancer treatment through the American Cancer Society in conjunction with several cosmetology organizations.

Her professional status enabled her proactively to seek out a highly skilled team of physicians to perform an elective bilateral mastectomy with reconstruction.

Wohlreich noted that reflecting upon her experience has helped her“ deepen my knowledge of myself, my beliefs, and the meaning of life.” In addition, she has found it “extremely important and meaningful” to share her experience with others.

Abigail Schlesinger, M.D., was a fellow in child and adolescent psychiatry at the University of Pittsburgh Medical Center's Western Psychiatric Institute and Clinic last year when she began experiencing flu-like symptoms and developed enlarged right supraclavicar nodes.

She hadn't seen a physician in several years, but concerned family members urged her to seek immediate care. Within days of seeing a primary care doctor, she saw a surgeon and was scheduled for a CT scan and biopsy.

“I felt as if I got Cadillac care because I was a doctor,” Schlesinger said.

As it was with Wohlreich, waiting for the biopsy results was the most difficult time for Schlesinger. “Once I heard from the surgeon that I had cancer, I was scared. I associated it with death,” she said.

She noted that “blame is unavoidable” when presented with a diagnosis of cancer.

“I blamed myself,” she said. Perhaps she had burned one too many food items, or there was something else in her environment that caused her cancer, she remembered thinking.

“To this day I still wonder, `Did I do something that resulted in me having cancer?'” Schlesinger said.

When she found out that she had lymphoma, she was relieved because she knew someone who had survived the disease, and she had read favorable statistics associated with lymphoma. “Not all cancer equals death,” she noted.

Schlesinger also benefited from strong support. “My family accompanied me to a lot of my treatments,” she said.

On the job, she spent time with her supervisor discussing her limitations.“ Did I think I could work with suicidal patients? Did I have enough energy to complete all of my work?” she asked.

But in addition to facing her limitations, Schlesinger also noted that her diagnosis and treatment gave her a profound awareness of her strengths.“ I knew what I could do no matter how I was feeling,” she stated.▪