Panel Discussion
Dr. Loren Mackinney: The pluralistic approach that Dr. Green has described imposes severe demands on the time, emotions, and skills of the physician who is not part of a well organized single-purpose cancer team. Incidentally, such teams exist in only a few medical centers at the present time. How can the consulting pediatrician in a medical center cope with the problems inherent with caring for such a patient and his family? What aspects of the many problems can be delegate to others? After this, which the physician must do himself, he can begin to ask others to help him. As the parents come out of their initial shock and daze and begin to take stock, it is very helpful to have a sympathetic, non-authoritarian figure make a relationship with the family and the physician. This person can be a social worker in the hospital, the family's minister, a hospital chaplain, or a friend. The physician may have to actively look for such a person to serve as a buffer and an informant. From this time on it is important for the physician to try to maintain good lines of communication between himself, the patient, and the parents. The social worker can be of great help in reviewing with the parents what the physician has said and reinterpreting it for them. Furthermore, she can report back to the physician the progress that the family is making in adapting to this new situation.
The second common problem is helping the parents to begin thinking constructively and positively about the child's remaining lifetime.
