By Dr Daniel Wong Wai Yan

I REFER to the article written by Dr Albert Lim (He saw 1,000 doctors, Fit4Life, Nov 15). As an oncologist, I have had similar experiences with patients who indulged in "doctor shopping" for reasons sometimes not completely clear to themselves, and I might add, often a waste of resources, especially when they go to a neighbouring country thinking they may obtain a better opinion there.

Certainly one of the potential reasons is the fear of death. I would agree that this has largely become a part of human existence in the 21st century.

Sadly, the medical fraternity has not conducted any large randomised controlled clinical trials testing the efficacy of therapeutic agents which may help with this morbid condition.

Death is an integral part of the circle of life and most of us have many years to prepare for it.

Physical death is a clinical diagnosis, i.e. fixed and dilated pupils, the absence of response to external stimuli, no breath sounds, no heart sounds, no palpable pulse.

One may fear death because of the pain of leaving family, friends and a familiar environment behind. However, I would put it to my "doctor shopping" patients who profess fear of death that it is in fact the uncertainty of what comes after that which is of primary concern.

Unfortunately most clinicians are not adequately equipped or do not have the time to deal with these issues. I wonder if my patients would appreciate me delving into such sensitive areas.

Medical care must be holistic. Whilst it is essential to help patients fight their cancer using surgery, systemic therapy, and radiotherapy, these alone are not sufficient.

Patients and indeed their families need to be supported in non-medical ways as well. I am extremely grateful to my palliative care colleagues who have the training, experience, and compassion to deal with these end of life issues.

We have weekly multidisciplinary meetings where the medical, psychological, and occasionally spiritual needs of patients are discussed.

Indeed, there are studies which have shown that patients with cancer who have spiritual or religious faith are able to cope better with their fears.

Although faith may to some folks be un-scientific in the strictest sense, if it provides comfort, peace and help (and yes - even eternal hope) to the patient, then it is to be encouraged.

Perhaps if a doctor had explored the underlying reasons for the extreme case of doctor shopping earlier in the patient's life, he might have saved some money, reduced the confusion over his medical conditions as well as reduced the amount of radiation which could have contributed to his subsequent cancer.

Spending a few minutes talking through the patient's concerns during the consultation and early referral to the appropriate professionals or clergy can go a long way in helping the patient, even if we do not have a magic pill!

PS: Could I please be introduced to Thomas?

Dr Daniel Wong Wai Yan is senior lecturer and clinical oncologist at University Malaya Medical Centre. For further information, e-mail starhealth@thestar.com.my. The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.