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Celebrating National Doctor’s Day With Samuel Kareff, MD, MPH, and Matthew Hadfield, DO

In this edition of the Oncology Data Fellows Forum in celebration of National Doctor's Day, Samuel Kareff, MD, MPH, and Matthew Hadfield, DO, discuss the highs and lows of working in this field and why it is important to take a moment to celebrate being a physician, your fellow physicians, and your patients.

 

Samuel Kareff, MD, MPH: Good afternoon, everyone. Welcome to the Oncology Data Advisor Fellows Forum, where today we have yet another very special edition where we are celebrating National Doctor's Day. I'm joined today by Dr. Matthew Hadfield of Brown University, and without further ado, we're going to go ahead and get this very special edition kicked off.

Dr. Hadfield, I'm very glad to have you joining me today because this is always a very special day, both inside and outside the hospital, but beyond the little luncheons, the little thank-you's, and that sort of thing, it's really just a source of pride. It really brings us physicians, as part of the provider network, a lot of joy to be able to celebrate our patients. That being said, in our field of oncology, sometimes things can get pretty rough. We deal with life-threatening illnesses, sometimes oncologic emergencies, and obviously there can be a little bit of an emotional toll with this sort of field. Dr. Hadfield, how do you balance the emotional heaviness of our occasional days with that of your mission of being a doctor?

Matthew Hadfield, DO: Thanks Dr. Kareff. It's always so good to talk to you. You make some really great points. I think oncology specifically is one of those fields where you see so much death and it really does weigh on you after a while. Personally, when I went through my residency training, I didn't find it to impact me as much as it did when I became an oncology fellow. I think the frequency with which I was having goals-of-care conversations had picked up so much. Just being with families—which is a really special thing to be with families during some of their hardest and most difficult times—also really can drain you quite a bit. I think doing things outside of work is really, really important. I play hockey every week, which is something I've been doing since I was a kid. So, those types of outlets, reading nonmedical books, spending time with family, things that really go by the wayside pretty quick when you get pretty busy, especially when you get clinically busy—I think making time for those types of things is really, really important because if you don't prioritize yourself, then you will suffer as you go through your training and career, in my opinion.

Dr. Kareff: I think you hit the nail on the head. I really liked the point you brought up about death and dying and experiencing it at different levels of our trainee continuum. As you and I are both finishing up our fellowship training, soon to be attending physicians, we've experienced this from maybe three or four dedicated levels so far. First as a medical student, of course, I'm sure you and I both can recall very clearly that first patient that we lost because that's just a very influential moment in our development as full-fledged physicians. And then as you alluded to, in residency, death and dying come in different sorts of experiences as well. I recall several experiences at the bedside, having to delay goals-of-care conversations or forecasting frightening scenarios overnight and that sort of thing. And that has evolved as we have finished our oncology fellowships to more conversations in the clinic trying to avoid these scenarios moving forward. Through and through, I've found there's always going to be a patient encounter or maybe a specific scenario that you really struggle with and it's super informative. So, I hope that we keep these pearls that we've gained throughout our training continuum very close to us as we enter our independent practice shortly.

Dr. Hadfield: Those are great points. Out of curiosity, what are some of the things that you've done throughout your training that help you balance the stress of being in oncology training and being healthy and well yourself?

Dr. Kareff: A lot of what you alluded to. I'm not a hockey player, but I'm a runner, so that is something that's very important to me to kind of sift through my thoughts, and in some cases start my day. And then you also alluded to the importance of family. I think now twice in my career I've made heavy location decisions that prioritize family and family access. That's just so critical to have the reliance of those closest to you throughout your life to make sure that you're able to be balanced and grounded through these tough times. So, my hope is that all trainees and all providers in oncology have that sort of rooting principle to make sure that they don't get too emotionally invested in this very difficult field occasionally.

Dr. Hadfield: That's a great point. Honestly, I've made similar decisions. My wife and I made similar decisions about being in the Northeast to be close to family, and I think that really resonates with me because one of the things I think was an unanticipated thing that I experienced in fellowship was as you meet more and more people that have cancer, and you see all these headlines about things like colorectal cancer now being diagnosed so much younger, as you start to meet patients—and it doesn't have to be younger patients—you really start to see, time and time again, people going through this, and it makes you confront your own mortality a lot. It really makes you think more and more that it is a precious thing to have another day to spend with your family. So, I think trying as hard as I can, especially on those tough clinic days where you're really far behind and everyone seems to want something from you, to remember it honestly is a privilege to be able to do this job, keeping things in perspective.

Dr. Kareff: Absolutely. I hadn't planned on sharing this detail, but since you brought it up, I think it blends nicely. In residency, I was actually very moved by a similar patient scenario that was linked to the passing of my father—who also was a physician by trade—right before I started med school, and I actually published it in a palliative care journal, called Confronting Our Own Mortality. I think it's so important what you say—because we deal with these topics often, and sometimes even as physicians, we kind of retain some sort of residual social stigma or lack of discussion of these topics. And it's so important, right? Because at the end of the day, we're just human beings serving other human beings as well. So, I really like that you made that point and I hope that it can at least spur some thoughts or discussion for those who listen to this episode today.

Dr. Hadfield: It's important stuff. I mean, it really, really is. You make a great point. We don't get any formal training—I mean, we get some training, and thankfully we're starting to talk about these things a little bit more—but particularly as it pertains to oncology, we don't talk enough about how hard it is to take care of patients who are, for all intents and purposes, beginning the dying process and how it can feel when you try as hard as you can. But science hasn't advanced far enough where we can cure everybody or treat everybody or give everybody more time with their families. And I think that was one of the things that I really—I wouldn't say I struggled with throughout fellowship, I just think it really has become more of a realization to me as I've gone through my training—that these things are something that we all need to start talking about a lot more, and kind of in the context of the broader picture of burnout across all specialties. I mean, we really need to start addressing this because it's something that is impacting all of us very much.

Dr. Kareff: Yes, absolutely. Piggybacking off the point you just made about burnout and how that's kind of contributing to a lot of this in oncology specifically, we're very well-versed with these tough conversations—not perfect, but well-versed. We've got a lot of practice with this. This is something we're constantly thinking for our patients and their families and trying to forecast or prevent certain complications, but obviously that takes a lot of support and it's not just at the individual level, such as in the exam room or inside the hospital and that sort of thing. It really is an all-hands-on-deck approach. What I've really appreciated seeing over the past few years—especially, maybe the COVID pandemic has accelerated this—but there's clearly a broader emphasis that systems are responsible for the wellbeing of their patients and their providers. So, it's not just something like these wellness walks that made a lot of the rounds through Twitter in 2020 and 2021, some way to just ignore what happened, but really to make sure that everyone is putting as much capacity and thoughtfulness into ensuring the wellness of the oncology workforce.

I think this is super important, and I would love to see every single cancer system prioritize this in their work mission or workflow. Of course, this will take time and recognition, but it's something I hope for and look forward to as I transition into attending-hood.

Dr. Hadfield: Absolutely, and two things dawned on me while you were speaking and raising such good points. I think there is a very prevalent stigma, particularly with physicians, but all providers, and I hear this a lot with physicians, this sort of adage that the financial compensation sort of outweighs the difficulties of the job. And to be honest, there's a lot of ways to be appreciated as a physician that don't involve more money or monetary things. The other thing I was going to say, and the reason that I was thinking about this is as we're talking about burnout and wellness and things, is I really feel like we have to look out for each other, our colleagues. When I was a first-year medical student, unfortunately, one of the students in my class took his own life, and that was a really hard thing to be a part of. I didn't know him well, but I think on the surface it seemed like he was doing great, and he wasn't.

Training is really, really hard. Intern years are very, very hard. Residency is very, very hard. I thought fellowship would be much, much easier than residency, and I think in many ways it's much, much harder; emotionally, it's harder, especially in oncology. The knowledge base is so much more difficult to manage as opposed to what you need to as a resident. And just taking a peek at what other people are doing or asking them, "How are things going?" I think could be so impactful and something that we kind of lose throughout our day-to-day activities.

Dr. Kareff: Without a doubt. I am sorry to hear of the loss of your medical classmate. I'm glad you had the ability to share it though, because I think a lot of us have these stories that we're maybe not as forthcoming with. My program coordinator in residency also lost her life to suicide, and it was just so shocking. Same sort of thing, a very happy-go-lucky person on the exterior, but of course, dealing with some intense struggles internally. And to our points earlier, this is a systems-based approach. This person's literal job was to support 90-plus resident physicians in going through their training, but she wasn't being supported herself. So, it's so important that we kind of keep an eye on this mindfulness and wellness generally, and I think that's crucial. So yes, I think conversations like ours today, although they might be somber on the exterior, are really important because we need to take a step back, make sure that we are proceeding through training, but also developing our own fortitude in the correct way to make sure that we can best serve our patients at the end of the day.

Dr. Hadfield: Yeah, and I hate to make the conversation too somber. I mean, especially on such a day that you're supposed to be thinking about celebrating physicians, but it's important, and I'm so sorry to hear about your program coordinator, but I think it is assistance that is the issue. You're totally right, and I think we really need to rethink this on a much more macro scale, but on a very granular level, we can all just be nicer to each other. I mean, we can ask each other how we're doing. We can fill in for colleagues when they're struggling, take some work off their plate if we can, while being mindful of own own capabilities and not doing too much of that. But it is tough. The demands are very high and it's a wonderful job, but we do need to have a lot more conversations about wellness and about how to actually sustainably make work better for people, because it's clearly becoming more of an issue. Thankfully we're finally starting to talk about it.

Dr. Kareff: Yes, absolutely. Maybe to change the emotional tone on the conversation, one of the very important tools to practicing wellness, but also ensuring fortitude, is practicing gratitude. So, maybe to end the conversation, I will share, and if you'd like, please feel free, one thing I'm grateful for being an oncologist. By far, the thing that has really struck me during my oncology training is how much my patients and their families look to me as their kind of care coordinator. Even though I'm not serving that role as the primary care physician, that is a role that I take very seriously and that I'm very honored to share. I'm very grateful that they give me that trust because we get to walk this journey called cancer together, and that's really a lot of the reason why I'm in this field today. Do you have anything to share?

Dr. Hadfield: Yes, you reminded me so much of an experience I had. So, I had a patient as a second-year fellow. She was 89 years old, had been married for 50 years, had this wonderful family, and she came to see me in clinic. She unfortunately had metastatic cholangiocarcinoma and didn't seem like a candidate for any type of systemic therapy. I talked to the family for a long, long time and the family had tons of questions. They were apprehensive with things, and she just stood up and said, "I love my family so much. You're all so important to me that I am ready to pass away." And everyone else started crying and she was smiling, and she basically said, "Let's go get lunch as a family, and I want to go to hospice." And when I think back on those moments, sometimes it's not the complete response on a computed tomography (CT) scan; sometimes it's not the research, the clinical trial, it's going really great, or the application—it's those moments. Those are the moments when families give you this ability and privilege to be a part of their, as you said so well, cancer journey. And sometimes that journey doesn't involve therapy, but you can be such an integral part of that, and it's such a special career in such a special field that I feel very, very fortunate to be able to do it.

Dr. Kareff: I couldn't agree more. Thanks for sharing that very uplifting story. I think that was very empowering for that patient for sure. We are very blessed to be in this field. Well, I've certainly appreciated the conversation today. I think we've adequately looked at some of the kind of happier and maybe more somber aspects of being a physician in our field, but at the end of the day, it's well worth it, and that's why we're here. So, thank you for being so candid, and thanks to all of our viewers for listening in on this special edition of National Doctor's Day. Hope you enjoy your day and thank you for all that you do.

Dr. Hadfield: Always a pleasure.

About Dr. Kareff and Dr. Hadfield

Matthew Hadfield, DO, is a Hematology/Oncology Fellow at Brown University/Legorreta Cancer Center in Providence, Rhode Island. Prior to fellowship, he completed his Internal Medicine Residency at the University of Connecticut in 2021. Dr. Hadfield's research focuses on melanoma and early-phase clinical trials. To date, he has published numerous peer-reviewed articles and studies, and he has presented his research at multiple national and international meetings. His main areas of interest include early-phase drug development, novel immunotherapeutic combinations to overcome therapeutic resistance, and predictive biomarkers for immunotherapy toxicities.

Samuel Kareff, MD, MPH, is a Medical Oncologist and a Hematology-Oncology Fellow at the University of Miami's Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital in Florida. He has special research interests in health advocacy, public policy, and the development of cancer therapies.

Transcript edited for clarity. Any views expressed above are the speakers' own and do not necessarily reflect those of Oncology Data Advisor. 


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