The issue of prophylactic surgical procedures, as an approach to cancer prevention, has recently come hurtling into the public consciousness, provoking reactions from a number of camps – and presenting chiropractors with an opportunity to demonstrate their informed, balanced, individual-centred approach to wellness and disease prevention.
The arguments are centred on when, and/or whether, prophylactic mastecomy is medically warranted, or if there might be a better way to deal with a genetic susceptibility to a potentially intractable disease process. Of concern, also, is the fact that celebrities are leading the way in advocating for these procedures. In his blog titled Respectful Insolence (scienceblogs.com), Dr. David Gorski, an oncologist specializing in breast cancer surgery, writes, “I’m not alone in being a bit worried that this announcement will provoke a run of patients demanding [a procedure such as double mastecomy] . . . regardless of whether it’s appropriate or not.”
Gorski also rails against critics lashing out at these cases with judgment calls. In doing this, he comes across as somewhat biased himself regarding certain approaches to prevention: “Given that breast cancer is a type of cancer that is not highly lifestyle- and diet-dependent...no amount of ‘anticancer lifestyle,’ ‘smart nutrition,’ and ‘avoidance of cancer-causing chemicals’ is going to lower that 85 per cent chance of breast cancer by very much….” In short, whether cancer is preventable is, of course, a complicated question and one that, evidently, has the potential to deepen faultlines rather than unify the health-care community.
In the face of such high-profile cases and issues, DCs can emerge as leaders in prevention dialogue, not just with respect to its content, but also with respect to its tenor. Patients need to have access to informed, person-centred options offered without judgment or bias. So, for instance, if critiquing a particular case, make sure you understand the entire context and what you’re dealing with. Half-truths, based on partial understanding, will not help anybody in the end, and may stand to hurt some patients. Offer facts and sound information objectively and welcome questions in an open-minded manner. Don’t diss entire systems or groups: remember that there are health-care workers in other disciplines who are as dedicated to helping people as you are. Diverse perspectives can be valuable and patients don’t appreciate having to navigate rivalries, on top of whatever health-care challenges they are facing.
As a DC, you can be a resource and a guide for evidence-based prevention strategies in a number of areas; as a health practitioner, you can be a reserve of empathy and understanding; as a member of the health-care sector, you can be a valuable partner for collaboration and integrated care that will benefit the public and contribute to clinically relevant knowledge.
As a patient, I would have much more respect for, and be more receptive to, a practitioner who helps me navigate the options in a balanced and non-judgmental manner, remains supportive regardless of my choice, and is available to guide and strengthen me through the course that ensues from my decision. I would also be much more likely to return to that practitioner and then refer my friends and family to them.
Bien à vous,
Editor’s Note: June 2013
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