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Table of Contents
Year : 2021  |  Volume : 4  |  Issue : 4  |  Page : 721-722

The process of unlearning

Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India

Date of Submission01-Nov-2021
Date of Decision06-Nov-2021
Date of Acceptance11-Nov-2021
Date of Web Publication29-Dec-2021

Correspondence Address:
Dharmishtha Ashis Basu
Rajiv Gandhi Cancer Institute and Research Centre, Rohini Institutional Area, Sector 5, Rohini, New Delhi, Delhi - 110 085
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/crst.crst_255_21

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How to cite this article:
Basu DA, Mukherjee A, Dewan A, Saha S. The process of unlearning. Cancer Res Stat Treat 2021;4:721-2

How to cite this URL:
Basu DA, Mukherjee A, Dewan A, Saha S. The process of unlearning. Cancer Res Stat Treat [serial online] 2021 [cited 2022 May 28];4:721-2. Available from: https://www.crstonline.com/text.asp?2021/4/4/721/334200

Residency comes with its own set of challenges. Stepping out from a world of pure Socratic learning into the clinical wards bustling with patients requires a certain shifting of gears that every doctor identifies with. With time, adapting to this transition becomes easier. After completion of a grueling 3 years of post-graduation, we had thought that nothing could surprise us anymore. When we started at the Rajiv Gandhi Cancer Institute and Research Center (Delhi, India), as 1st-year medical oncology residents, we came with the mindset that we would hardly feel a change. But boy, were we wrong!

Getting through a national-level entrance exam often fills us with a sense of pride and accomplishment that we carry to our place of work. However, the sheer inadequacy of knowledge along with the need to know more and more, hit us like a ton of bricks in our very first week. Unlearning complacency and emptying the mind for new knowledge was the need of the hour. With time, files full of oncological jargon became more decipherable. Orders from consultants became more predictable. Eventually, things started getting done before they were asked for. However, the relentless need to know more persisted.[1] We are grateful to our mentors for their reassurances that try as we may, this feeling of inadequacy would probably be a constant companion.

On the one hand was the quest for knowledge, and on the other was the need to establish a relationship and to own the responsibility of our patients. It was now time to realize that we had come to work for an institute that had maintained one of the highest levels of excellence in cancer care and had, in the process, earned the loyalty of hundreds of patients and their families. Now, we had become a part of this legacy, and it was time to prove our worth. The first delayed discharge summary made it amply clear that our delays and mistakes now meant financial implications for our patients.

Patients with cancer have a unique relationship with their doctors. Essentially, they all fall prey to the unshakable feeling of impending doom, fear of an at best inconvenient and at worst, morbid treatment riddled with side effects, and minds filled with advice from well-meaning relatives and social media. They look to us to tell them repeatedly that it will all be fine and that things are not as bad as they seem. Unlearning indifference and getting truly involved with day-to-day patient care was the next step. As rightly stated by our mentors, our behavior toward patients should be what we would expect from the doctors treating our family members. This is the mantra we try to live by and hope to refine each day.

Doctors are often warned about the emotional burnout associated with excessive bonding with patients.[2] Taking their disease and the outcome too personally often brings us to a state of worthlessness. However, this effort to avoid emotional investment comes at the cost of sounding distant and cold to our patients at their most vulnerable moments. Maybe the concept of emotional distancing to protect one's own sanity in the face of never-ending work pressure needs some modification. When we hold a patient's hand from their first visit to their last breath, maybe we do end up becoming more than strangers. Maybe our patient's emotional expectation from us is more than that in other clinical fields, because despite all our counseling right from the day of diagnosis, they live with the realization that death due to this disease is inevitable. Unlearning the traditional concepts of time-bound duties and handover hence becomes necessary. Going the extra mile for the patients, thinking about their welfare, and worrying for their well-being beyond the period of hospitalization probably stem from the realization that we will soon become consultants and will be wholly responsible for our patients one day.

Our first few months here taught us that emotions run high in a cancer institute. Staring at a morbid diagnosis of a loved one with expensive treatment that does not always yield the expected result, the immense amount of patience, and perseverance from the families makes a combustible combination. We learned soon that the choice of words and the tone of speech are of utmost importance. Right words spoken at the right time can avert a potential catastrophe.[3] Communicating with carefully chosen words in a measured tone with sensitivity and patience was a lesson we learned from our mentors over the next few months.

Probably, this residency is more than just a job. It is a calling. This is what we were meant to do. “Tamaso Ma Jyotirgamaya” (Tamaso Ma Jyotirgamaya = Lead us from darkness to light). We pray that with knowledge, training, and further refining ourselves not just as medical oncologists but also as human beings, we can ease the pain of countless people and lead several helpless souls from darkness to light.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Noronha V. The need to know. Cancer Res Stat Treat 2019;2:135-7.  Back to cited text no. 1
  [Full text]  
Singh S, Sharma R. Thwart embers before they become an inferno. Cancer Res Stat Treat 2021;4:433-4.  Back to cited text no. 2
  [Full text]  
Chittem M, Maya S. A twist in the tale: Alternate methods to communicate, or are they great expectations? Cancer Res Stat Treat 2020;3:360-1.  Back to cited text no. 3
  [Full text]  


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