Relationship of the Physician in Practice to a Children's Cancer Clinic

I WANT to make clear in the beginning that I am not a hematologist, and I am certainly not a cancer expert. However, I have been asked to present the views of a general pediatrician. I have divided the content of my presentation into three areas. First, the initial period of diagnosis of malignant disease in a child; second the relationship of the primary physician, or the practicing pediatrician, to the family and the clinic in the course of the illness; and, finally, the relationship of the physician to the family and clinic during the terminal stages and, indeed, after the death of the child. TIME OF INITIAL DIAGNOSIS First of all, at the time of the initial diagnosis of cancer and a malignant disease in a child, all physicians who serve as family physicians go through some rather serious self-searching problems of their own. This is not a straightforward illness, and there is a great deal of concern, such as "did I miss this diagnosis or did I completely overlook something critical here that has been going on for some time." This is a question that almost everybody who is thoughtful in their relationship with children will ask themselves. In some, it is a very destructive kind of response and, in others, perhaps constructive; but, nevertheless, it is a real one and a frightening one for a physician to face. Secondly, many physicians ask the question: "How can I get rid of this patient? Nobody likes doctors who take care of dying kids; how can I unload this patient?" I am talking of what many people have told me of their feelings.