Nov

14

2021

Perspectives From Doctor as Patient

By Helen Osborne

Shaun Richard McCann received his MB from University College Dublin. He became a Member of The Royal College of Physicians in Ireland (MRCPI), by examination, in 1973. He was a specialist medical fellow at the University of Minnesota from 1974-76. The main focus of his research then was red cell structure and function, especially in hereditary spherocytosis. Shaun became a member of the Royal College of Pathologists (MRCPath) by examination in 1978. He was appointed consultant hematologist to St James’s Hospital, Dublin, and carried out the first successful bone marrow transplant in Ireland in 1984. He was appointed as National Medical Director of the Irish Blood Transfusion Service by the Minister of Health in 1995 during the Hepatitis C controversy. He was appointed Professor of Academic Medicine in Trinity College in 2005, with responsibility for administering the School of Medicine. He was awarded Honorary Fellowship of the College in 2006 (Hon. FTCD). Shaun’s books include Clinical Cases Uncovered: Hematology (Wiley-Blackwell, 2009) and A History of Hematology: From Herodotus to HIV (Oxford University Press, 2016). He has a major interest in wine and published An Immodest Proposal – Wine and Health under his pseudonym Giovanni Morelli and Wine and Blood: An Unlikely Pairing by Shaun McCann in 2020. Shaun has also been writing editorials for the journal Bone Marrow Transplantation on the relationship between hematology and wine since 2018.

Fertility and Wine – Science & Wine
Dr. Shaun McCann
Wine and Blood: An Unlikely Pairing: McCann, Shaun R.: 9789975341776:  Amazon.com: Books
Front cover of McCann’s book on Wine and Blood: An Unlikely Pairing, Eliva Press 2020. 

In this podcast, Shaun McCann talks with Helen Osborne about:

  • Trusting healthcare professionals
  • Showing empathy
  • Perspectives as a physician coping with his own illness

Music by Skilsel from Pixabay.

Producer and audio editor: James Aird

Transcript:

Helen Osborne: Welcome to Talking about Blood. I’m Helen Osborne, host of this podcast series and a member of the Advisory Board for The Blood Project. I also produce and host my own podcast series: Health Literacy Out Loud. Today I’m talking with Professor Shaun McCann, a hematologist who carried out Ireland’s first bone marrow transplant for leukemia at St James’s Hospital. He also was Professor of Academic Medicine at Trinity College in Dublin. Professor McCann is the author of several books about hematology and has written numerous book chapters and scientific articles. In addition, he writes a monthly essay about the connection between wine and medicine for the Bone Marrow Transplantation journal. Welcome Shaun to Talking about Blood.

Shaun McCann: Well hello Helen, thank you very much for the invitation.

Helen Osborne: Well you and I are both members of the Advisory Board for The Blood Project and we’ve been getting to know each other as that site’s been developed, and that’s been wonderful. I know you and I have had several conversations about hematology and blood and the experience of illness, and I welcome you sharing a little bit about that experience of illness with a serious blood disease.

Shaun McCann: Ok, well first of all, to say I was in charge of a large hematology unit for over 25 years and spent most of my adult life, I guess, treating people with potentially fatal illnesses like leukemia and related diseases. I suppose like most doctors, you think you’re going to live forever and you’re never going to get one of those terrible diseases that you treat because if you didn’t think that, you’d go absolutely and completely crazy.

Many times when I walk through our day ward facility, which is where our chemotherapy and blood transfusion etc. is administered. I thought to myself, “How would I feel if I was in their position?”. The answer was it eventually happened to me in November of last year.

Helen Osborne: So being a doctor is not that magic potion to keep us well forever.

Shaun McCann: No, doctors die (ha-ha) like everybody else. Doctors get sick. And doctors by and large make very bad patients.

Helen Osborne: Oh, Sean, please tell us all more about this.

Shaun McCann: Let me say first of all, Helen, I learned something very important when I was in the hospital – it’s much for fun to be a doctor than a patient. However, I think all doctors probably should be patients to experience what it’s like on the other side. I was a little bit taken aback, needless to say, at the diagnosis, but I made a decision immediately that if I had to be treated and go into hospital, I would not be a pain in the ass and be a professor and a doctor. I would just be an ordinary Joe. I think the second thing is you have to trust the people who are looking after you and I guess I was in a strange position. The people looking after me, I used to teach them. So, it was a measurement of how well I taught them, I suppose. Thankfully, they have done a very good job. At the moment, I’m in complete remission and feeling extremely well. I think the bottom line is that you have to trust people (who look after you).

Helen Osborne: You need to trust the people who are treating you?

Shaun McCann: You have to. There’s a whole .. the pendulum has now swung where the patients are involved in every single decision about their treatment and diagnosis and that can be overplayed, I think, and can actually increase the anxiety.

Helen Osborne: Can you give an example of that?

Shaun McCann: Yea, my example actually goes back a long time to when I was a fellow at University of Minnesota in the mid 1970s while you were still in diapers. University of Minnesota was a referral hospital for 5 of the states and we got this old farmer who wore denims – I mean this was before denims were fashionable – he wore the real denims. I won’t go into the details but he had a disease, a lymphoma, and the treatment wasn’t quite worked out at that stage. We had a long conversation which is right and proper among the all the fellows and trainees and professors about what to do with him. But when we went to his bedside, to my amazement, the professor said, “Well we are not sure what we should do”. I looked at the patient and he was crying. And he said, “Well if all you smart people in white coats don’t know what you’re doing, just fly me back to North Dakota again”. And I thought, you know, that was a really bad way of handling the problem. Even though you may not be sure of the answer, you still have to say to the patient, “We will do our best. We will look after you”. And that’s what they want to hear. And what you’re paid for… and most of us are paid extremely well, is to learn to make the right decision most of the time.

Helen Osborne: When you were talking about decisions, Shaun, you’re taking a different tactic than I thought. I thought, because I’m not a physician, and my work is all about health communication, I thought you were going to go in the direction of asking patients to make decisions and how hard that can be. And I know that in my healthcare in a lot of ways, sometimes we’re asking patients to make decisions that perhaps the providers should be making or guiding us such as: “Do you want this treatment or that treatment?” I know in my own life sometimes I don’t know what flavor ice cream I want when I go to the ice cream store. Are we asking too much of patients?

Shaun McCann: I think the best example is when I used to counsel patients for bone marrow transplantation, I had to go through all the potential possible side effects etc., etc. But at the end of an hour and a half I would ask the patient, do you have any questions? I always got the same question: “What would you do doc?” Which really is saying what you’re saying in another way: “Look I came here for advice. You know what the problem is. You advise me what to do.” And that’s what we should do. Of course, you want to explain what you’re doing, but I agree with you, we shouldn’t let or make the patient make a choice because patients are by definition unwell, suffering, and anxious. So, they don’t want to be making these difficult decisions. That’s what we’re supposed to be doing. Giving advice. And our colleagues are supposed to be making sure that the advice is good advice, most of the time.

Helen Osborne: I like that. Good advice, most of the time.

Shaun McCann: Well I mean we can’t be right all the time. A senior colleague of mine said once to a patient: “Well you know, it’s hard to be God all the time”. He didn’t really mean that but it just sounded very funny when you say it like that. But, I mean you do have to make decisions which are what we would say 50/50 sometimes. You know, there is no absolute certainty to the outcome of anything as we all know as we get older, and I think one of the problems in the current world is patients are people who want certainty, which doesn’t exist in the world – except we are all going to die, and as the other one said income taxes ha-ha. Bob Hope said ha-ha.

Helen Osborne: I wonder if you could just give a dose of advice for those who represent probably the key listeners or audience for The Blood Project or for this podcast. So for trainees, a lot of people who are becoming doctors or  want to become doctors, what would you want them to know about this experience of illness, and what they might take with them in their future career?

Shaun McCann: I think all doctors should be very aware that patients are very frightened people. And, they are relying on your expertise. So, you have to reassure them you are going to look after them. I’ll just give you a very brief example. I got a phone call, actually from North America, a friend of mine. This friend of his had Hodgkin’s disease which had relapsed three times. She was going to die. She went to California, to Seattle, and to New York looking at the transplant protocols. And they were all slightly different, so she got very anxious. So, they rang me and I said look, “You live in Washington. Go down to the NIH, they are very good doctors. Get treatment. Your family can be beside you and you’re probably going to die.” And that’s exactly what happened. But nobody in California, or Seattle, or New York had put their arm around her and said: “Look. We’ll do the best for you”. I think that’s what doctors should say.

Helen Osborne: Shaun, I’m getting goosebumps listening to you. Thank you. Your kindness and humanity is just coming through, across the ocean to me, as I’m in Massachusetts. So that’s your advice for trainees. What about your advice for practicing physicians who might be seeing patients all the time. They’ve been through years of this. What lessons would you want to share with them?

Shaun McCann: I think they’re not that different, actually. Look, the worst thing that can be done when you go to see a doctor is the doctor looks at a computer screen all the time and doesn’t make any eye contact or shake your hand, or put his arm around you, or whatever. So, I think the thing is that the connection between, the physical connection between, like touching somebody is very important. I’m sure I’ve told you before a number of examples of friends of mine, including some of my own family, who went to a doctor who never examined them. Just ordered very expensive tests, which in themselves are very rarely diagnostic. I think the listening, touching, and showing that you are concerned. As a famous colleague of mine said in the UK, “Patients want to know how much you care, before they want to know how much you know”, and I think that’s absolutely true. I mean patients expect that you’re trained to a reasonable level, and most doctors nowadays for all the reasons we know quite well are adequately trained. So it’s the humanity and that side of things we seem to be losing.

Helen Osborne: Thank you Shaun. Ok, last bit of advice is for people who are patients.

Shaun McCann: First of all to say, don’t expect it to be fun because it’s not. And the second thing is, you trust the people looking after you. You ask the important questions but you don’t try and manage or micromanage the situation, otherwise you go crazy and you drive everybody else crazy. And remember that healthcare professionals are human beings as well. So, if you relate well to them, it helps them to relate well to you. I know it sounds a bit trite, but it’s absolutely true.

Helen Osborne: Oh, Shaun, your truisms are so powerful to me. I thank you so much for being candid about your situation and being open to sharing that. But also for teaching all of us how to be better as we enter the field, we’ve been doing it a long time, and for whenever that time comes, whatever that diagnosis is, for all of us being better patients too. Thank you so much for sharing this and being a guest on Talking about Blood.

Shaun McCann: Well thank you again for asking me and I hope my comments are of some help to somebody, somewhere.

Helen Osborne: Thank you Shaun.

Shaun McCann: Ok. Ciao.

Helen Osborne: To learn more about The Blood Project and explore its many resources for professionals, trainees, and patients, go to www.thebloodproject.com. I invite you to also listen to my podcast series about health communication. It’s called Health Literacy Out Loud at www.healthliteracyoutloud.com. Please help spread the word about this podcast series and The Blood Project. Thank you for listening. Until next time, I’m Helen Osborne.