Correspondence

The Wellness Community Statement

N Engl J Med 1995; 332:962-963April 6, 1995

Article

To the Editor:

Faith T. Fitzgerald, M.D., reviewed (Nov. 3 issue)1 Michael Lerner's book, Choices in Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer.2 On page 69 of that book, under the subheading “Establish a Working Relationship with Your Doctor,” Dr. Lerner quotes the full text of “The Wellness Community Patient–Oncologist Statement” drafted in July 1984 by the director of the Jonsson Comprehensive Cancer Center (University of California at Los Angeles) and four oncologists in concert with the founder and president of the Wellness Community.

Dr. Fitzgerald misconstrued the statement to be a contract by which the physician promises to provide adequate medical care to the patient. She says, “Although such a contract may be pragmatic and useful, it suggests a mutual distrust between patient and physician and has all the negative implications of a prenuptial contract.”

A reading of the statement will make it clear that it is by no means a contract, nor does it suggest mistrust. On the contrary, it is a statement to be given to the patient by the physician as the basis of a conversation about the most effective psychosocial relationship between them.

It is important that misapprehension about the purpose of the statement be rectified and its true meaning understood, because there is still a problem of distant and impersonal treatment of some patients with cancer by some physicians and oncologists. A 1994 study suggests that such treatment is not in the best interests of the patients: “The more satisfied with the professional and personal qualities of their physician as well as the cost and convenience of health care, the better the overall psychological adjustment of the patient.”3

We believed at the time the statement was drafted, and we still believe, that its affirmations, though not all-inclusive and not applicable to all situations, are a reasonable basis for a conversation between physician and patient that will, if nothing else, beneficially affect the social interaction between them and the quality of life for both of them and that may serve as a checklist for those who are in daily contact with patients with cancer.

Richard Steckel, M.D.
UCLA School of Medicine, Los Angeles, CA 90024

Laurence Heifetz, M.D.
Cedars–Sinai Medical Center, Los Angeles, CA 90048

Harold H. Benjamin, Ph.D.
2716 Ocean Park Blvd., Santa Monica, CA 90405

3 References

1. 1

   Fitzgerald FT. Review of: Choices in healing: integrating the best of conventional and complementary approaches to cancer. N Engl J Med 1994;331:1244-1244
   Full Text

2. 2

   Lerner M. Choices in healing: integrating the best of conventional and complementary approaches to cancer. Cambridge, Mass.: MIT Press, 1994.
   

3. 3

   Rodrigue JR, Behen JM, Tumlin T. Multidimensional determinants of psychological adjustment to cancer. Psycho Oncol 1994;3:205-214
   CrossRef | Web of Science

Author/Editor Response

Dr. Fitzgerald replies:

To the Editor: I did not misconstrue the “wellness statement” to be a contract by which the physician “promises to provide adequate medical care to the patient.” It deals with interactions between patient and doctor and outlines the responsibilities and duties of each in communication with the other. But I believe the authors' assertion that the statement is by no means a contract is naive at best and defensively sophistic at worst. I sent the wellness statement to a local attorney well versed in malpractice law, who informed me promptly that it does correspond in all regards to a contract. It was the author of Choices in Healing who advised patients to consider bringing it with them “to an early meeting with your doctor, explaining that it is a cosignatory pledge agreed to by many patients and oncologists in Los Angeles and elsewhere, and asking if it might serve as a basis for an understanding between you and him.”

All the components in the statement are part of the implicit, and often discussed, physician–patient relationship. Making them explicit in a written document brought by the patient to the physician to be signed by both parties does smack of legalism and distrust, whatever the intention of the originators of the statement. Moreover, it is most likely to serve the already converted: autocratic, distant, or aloof physicians are unlikely to welcome this statement or be changed by it, and patients who are timid, shy, or easily browbeaten are less likely than more assertive patients to present such a document to their physicians. Thus, patients who bring it to their doctors, and doctors who are receptive to it, are the patients and doctors who appear to need it least.

Faith T. Fitzgerald, M.D.
University of California, Davis, School of Medicine, Sacramento, CA 95817-2282