I*Care Roundtable Discussion with Dr. Richard B. Patt Video Transcript

I*Care Roundtable Discussions
Interpersonal Communication And Relationship Enhancement (I*CARE)
Dr. Richard B. Patt
I*Care Roundtable Discussion with Dr. Richard B. Patt
Date: November 6, 2012
Time: 28:44

Richard B. Patt, M.D.
Associate Professor of Anesthesiology and Neuro-Oncology
Director of Anesthesia Pain Services and Deputy Chief, department of Pain and Symptom Management, MD Anderson Cancer Center
Medical Director of Inpatient Services, Hospice at The Texas Medical Center President and Chief Medical Officer, The Patt Center for Cancer Pain and Wellness


Dr. Baile: Hello. I'm Dr. Walter Baile, director of the M.D. Anderson Program on Interpersonal Skills and Relationship Enhancement. Today we're pleased to welcome Dr. Rick Patt as our I*CARE roundtable speaker. Dr. Patt trained in anesthesiology at Albert Einstein College of Medicine where he also completed a Pain Fellowship. After this, as Associate Professor of Anesthesiology, Psychiatry, and Oncology, he became director of one of the world's first dedicated pain centers at the University of Rochester Strong Memorial Hospital. Here, he helped establish the Center and an ACGME-approved Fellowship Program. In 1993, he was recruited to M.D. Anderson Cancer Center to organize and direct their section on pain management and symptom control. Here, he was responsible for dramatically enhancing the ability of the institution to deliver interventional procedures for cancer pain. In 1996, he established the Patt Center for Cancer Pain and Wellness where he cared for patients with cancer and chronic pain. Subsequently, he was on the staff of Saint Luke's Episcopal Hospital where he headed up the Pain Control Task Force and also was director of inpatient services at the hospice at Texas Medical Center.

During the course of his career, Dr. Patt has written extensively on the topic of cancer pain serving on the editorial boards of 15 journals. He's also written over 60 textbook chapters and over 60 articles in peer reviewed journals. A notable accomplishment is the fact that he edited the first comprehensive text on cancer pain, called "Cancer Pain," and coauthored the first self-help book for patients with cancer pain and their families, which was called, "You Don't Have to Suffer: A Complete Guide to Relieving Cancer Pain for Patients and Their Families." This was published by Oxford Press in 1994.

Dr. Patt has given over 500 invited lectures, 30 workshops, and trained hundreds of pain fellows. And during the course of his career, he's faced two very personal challenges, including dealing with addiction to stimulants, tranquilizers, and opioids in 2006, and his recent diagnosis for metastatic lung cancer. He was successfully treated for the former and returned to full-time practice. For the latter, he's currently being treated and thankfully is responding to treatment, allowing him to pursue his favorite hobby, playing with his band. Today, he's giving an I*CARE lecture entitled, "From Doctor to Patient: Cancer, Pain and Dying." Rick, welcome.

Dr. Rick Patt: It's great to be here, Walter.

Dr. Baile: We go back a long way, 2006, maybe a little before that, right?

Dr. Rick Patt: That's right.

Dr. Baile: Yeah, we were both in the same -- folks don't know that we were both in the same department for a period of a couple of years.

Dr. Rick Patt: Yeah.

Dr. Baile: Yeah.

Dr. Rick Patt: And in our pain program, we relied considerably on psychiatry.

Dr. Baile: Right, right. So first, let me ask how things are going for you with your treatment for lung cancer.

Dr. Rick Patt: Well, I'm really receiving pretty modest treatment. I've got Stage 4 disease, which is unfortunate and is not very responsive to treatment. I, in fact, deferred chemotherapy, which was recommended, but my treating physicians seemed pretty comfortable with my decision not to get chemotherapy. And only recently did I complete a course of radiotherapy that actually has been helpful. I don't reckon that it's curative, but I think that it may extend my survival and hopefully will keep me feeling good for a period of time, so I can play music, like you said.

Dr. Baile: Tell me a little more about your decision to forego chemotherapy and how you came to that conclusion that that wasn't something you wanted.

Dr. Rick Patt: I think it was simply a good decision for me, and frankly, probably would be for many people in my situation, although I think that it's probably a pretty uncommon choice. But, you know, armed with what -- and it's very difficult to -- even with the most expert counselors to interpret the risks and benefits of treatment versus no treatment -- but, you know, when I was considering it, I came across a good peer reviewed article that randomized patients to standard treatment for the kind of lung cancer that I have versus what they call palliative and supportive care, and they found that the patients in this so-called nontreatment group not only had better quality of life, but actually had better survival. So I was unconvinced that even the modest side effect burden of chemotherapy and the fact that it would probably take the wind out of my sails was worth, you know, the very modest chance of extended survival.

Dr. Baile: So the tradeoff for you was clearly one of wanting to have a better of quality of life and possibly even a bit better survival compared to patients who got chemotherapy.

Dr. Rick Patt: Well, I really think that it's the former, that it's the very rare person, you know, with the illness that I have, that's going to survive beyond a year or so, and I just wanted to spend it feeling as good as I could, and I didn't want to drag my family through all of the, you know, problems associated with getting chemo.

Dr. Baile: So let me talk, address that issue for a moment, because in my experience, it's also very hard for family to accept when patients don't go full course ahead with a treatment for cancer. And I'm wondering, did you get much pushback from family or your doctors about your decision?

Dr. Rick Patt: Surprisingly not, and I don't know if that, in part, is related to the fact that I am a physician and there was an assumption that I could make sense out of, you know, what I was hearing or not, but, no, my family's been supportive, and the doctors, as well, have respected my decision.

Dr. Baile: And perhaps we should know that one of your passions is guitar playing and leading your band. And I would sort of like to ask you that in retrospect, has your period now of not being under, not undergoing chemotherapy, how has that helped you do the kind of things that you wanted to do with your music.

Dr. Rick Patt: Well -- let me, if it's okay, let me, and there's something else I'd like to get to before discussing that --

Dr. Baile: Okay.

Dr. Rick Patt: And that is you had mentioned that I had a very serious problem with -- I was an impaired physician and had a problem with drugs and alcohol. And I think that that experience was one of the most powerful --

-- tools in my belt for coping with my current circumstances. You know, it was really -- when I recognized that I needed help and I surrendered my license, it was a really awful time. And I either lost, you know, just about all that I held dear, or I certainly experienced the threat of those losses. And I really feel like I went through those stages of grief that Dr. Kubler-Ross talked about 10 years ago, and that it kind of prepared me for my current circumstances, if that makes any sense. It was a real low point and I really had to look at what was important and what isn't important in my life. And despite all my accomplishments and all the flurry of activity in my academic life, those things weren't really making me as happy as they might.

Dr. Baile: Well, thank you for saying that, because it leads me to another question for you, that I was reading the story in the Houston Chronicle about your journey, so to speak, and I read something very kind of interesting that, you know, from when I knew you, of course, you had just finished your book and you were traveling extensively, and at the same time trying to manage the pain service at M.D. Anderson. And I noticed that when you had talked about beginning to kind of take stimulants as a way of sort of not getting fatigued, because it sounds to me like the candle was really burning at both ends during this period of time. And so I wanted to ask you about this kind of intoxication of success and sometimes what it can do to people, because I had the feeling also that, you know, you were at a time in your life when really the sky was not only the limit, but people were tugging at you from many, many different kind of directions.

Dr. Rick Patt: It was a very heady time, and I was really on top of the world. To be totally clear, my problems with substance abuse arose much later, and in fact, I think, had to do with the withdrawal from that -- you know, how much was going on when I was here at Anderson. I was kind of addicted to being a doctor, and to achieving all of these things, and each of these new accomplishments were very satisfying. And I didn't need a drug at the time because -- you know, if you're not careful, I came to see myself only as this sort of superstar physician, and I was neglecting other parts of my life. And that leads to a different kind of stress. But it was only after I left the institution, went into private practice, began to feel more isolated, I really missed, you know, working with residents and fellows that I began to self-medicate. So I think my -- I think that the pace that, you know, a really successful physician often assumes is associated with some risk.

Dr. Baile: So speaking of physicians -- that you've been in treatment for your lung cancer for how long now?

Dr. Rick Patt: Since March of this year, so I guess that makes it about 8 or 10 months.

Dr. Baile: Since the focus of our program is on clinician/patient communication and communicating with patients and families, can you say something about your experience as a doctor with the medical system and with physicians who've taken care of you and nurses who have taken care of you. How's that gone for you?

Dr. Rick Patt: Well, pretty good. The institution here does a great job, but I think that it is so challenging for them to -- for us to do everything we need to do, just to deal with the hardball aspects of the illness, much less that sort of whole person part of it and the amount of time that's allotted, it leaves -- I can see that it's very hard to address all the concerns that patients have. There really just isn't enough time.

Dr. Baile: So being in the shoes of the patient, that gave you some appreciation for how people were pinched for time. Were there things that you would have liked to have talked about or things that you would have liked to have gone differently that didn't go because you were perceiving that people were rushed?

Dr. Rick Patt: You know, yes. Again, the -- you know, even with my background and training and my trying to bone up on my circumstances, I really wanted to pick the brain of the expert whom I was with, and while ultimately we did accomplish everything we needed to, I was really conscious of the pace and the tempo in the clinic, and the recognition that I needed to use the time very carefully because the doctors there were so busy.

Dr. Baile: You read that a lot in the literature about patients' perceptions of not wanting to bother the team with questions when they perceive that they’re rushed-- it's really, I guess, hard not only to find a moment with the physician, but also -- I wonder also to get the message that -- from other people who are taking care of you that they might have the time to do that.

Dr. Rick Patt: Yeah, and I guess I fell into that trap. I kind of forgot that they were there to take care of me and it wasn't my job to look after them and their schedule and their sensibilities.

Dr. Baile: Not an uncommon feeling, I think, when you're on the patient end of the treatment team.

Dr. Rick Patt: But in general, there was a pretty wide acceptance of my choices. Only on one occasion was I disappointed that a consultation that I underwent, the doctor really didn't seem to be prepared or really know very much about me and my illness, nor the choices that I had made, and came in kind of like a steamroller with their own agenda about what treatment they thought was appropriate, and really didn't give me a chance to verbalize what my needs were. And in my case, I just kind of rolled my eyes and looked at my wife, because she knows that, like you, I'm a huge proponent of doctors listening to their patients, and it was clear that this was not going to be a good use of anybody's time and that it was not going to go well. But I really felt badly for a less assertive and less experienced individual that would come for a consultation like this and really would not get a chance to find another doctor or be heard about what their concerns were.

Dr. Baile: Did you find at all that some of the clinicians who attended you were in any way uncomfortable in talking to you about your decision or your disease because of the fact you were a doctor?

Dr. Rick Patt: No. I think, in general, there was a sense that they could kind of cut to the chase, and there was a recognition that I was already coming to the table with a reasonable background that would make their job a little bit easier to move forward.

Dr. Baile: So I wanted to ask you about one of the more important things in your life now, not only your wife and your son. I guess your son is 22 now?

Dr. Rick Patt: That's right, and my dad is 95 and lives with us.

Dr. Baile: And your dad is a doctor?

Dr. Rick Patt: Yeah, he was, you know, 50 years ago.

Dr. Baile: He was a doctor, okay.

Dr. Rick Patt: He's forgotten that now.

Dr. Baile: And you're able to play in your band?

Dr. Rick Patt: Oh, yeah, I wanted to get back to talking about music. It's been wonderful for me. You know, it's kind of ironic that now that I'm near the end of my life, I've really discovered my voice and, you know, playing with a band has always been a great metaphor to being in the moment in life. You can't really be behind the beat or ahead of the beat very long before things start to fall apart. And so it's a wonderful feeling to make music. And I've really come to appreciate that there's a creative act, a creative force that occurs when the band makes music that really engages the crowd, and it's really a great way of being with people. And I -- you know, fatigue has been a big part of my symptom burden, and I'm really energized by playing music. It is my -- any ideas about pain or anything negative simply just go away completely, so -- we've just come out with a CD and I'm looking for just about any chance I can to play. I've done some playing as a volunteer, because, at least for me, it really is very powerful medicine. And, you know, I would hope that other people in my circumstances -- it may not be playing music for them -- can find something to engage in that elevates their mood and --

Dr. Baile: I was just thinking about what an important lesson that is for, you know, we doctors who sometimes are taken a little bit aback at patients who don't want to go full course with every treatment right up until the end with the hope of somehow getting a miracle, and you know, the emphasis today is to try instead to stay centered on the patient and what their goals are. And to try to make treatment recommendations depending upon what the goals of the patient are. And it's -- just to reflect on it, it just seems to me that this was something that was important to you to be able to pursue that you may not have been able to pursue if you had undergone further treatment or continuous treatment.

Dr. Rick Patt: One of the greatest moments, and I found it pretty easy to do, again, I think is in part because of all the losses I encountered, you know, 8 to 10 years ago with my recovery. But everybody initially wanted me to fight, you know, to fight the good fight. And I didn't really want my last days to be about fighting some stupid fight that I didn't ask for and that I couldn't possibly win. It sounded awful to me. So I just basically said, I give up, I surrender. You know, the cancer is going to do what it's going to do, I have no control over it. And I really encountered such a great feeling of relief. It was really a big, big moment for me, I mean, and I think that there are ways to continue to have space for miracles, but for me, a miracle is going to be a day that's pain free or a night of uninterrupted sleep, or even a good bowel movement. And I am the architect of my life, and I choose to celebrate those as momentous moments, you know, I'm spending time with my dad, I'm playing music and celebrating that. I really don't, I don't want to fight right now. I don't want to have that be what -- you know, I mean the end of my life is a significant time, and I think that I can do things that are more meaningful than --

Dr. Baile: So I was kind of just reflecting on how we use these war metaphors in medicine, you know, and the idea that if you're not fighting, you've sometimes given up, but on the other hand, it sounds not like you've given up, but that you've accepted and moved on to living life the fullest and actually, from what I understand, you've kind of found a different level to your music that hadn't been there before.

Dr. Rick Patt: Yeah, it's been extremely healthy for me. I'm writing songs for the first time because I kind of feel like I have something to write about. Yeah, I don't know why it should stickin our throats so badly that we're going to die. I mean, it's so obvious, and I really feel blessed to have kind of more information than many others do so that I can make this a big time. You know, one of the first things we did, because we're financially strapped, was we held a -- I've been very active on the board of the Houston Blues Society, and we held a benefit for my wife and I, and it was being at this great party and celebrating my life while I was there to participate. And my brothers came, and we all played music together. So this is a good time. This is like, I think like the best time in my life. I'm kind of seeing it like a field trip. It's very interesting.

Dr. Baile: So, you know, while -- just thinking about what you had said previously about the losses that you had and that while cancer is a disease of loss, because you lose a lot, you know. You lose your stamina, you lose your financial security, a lot of things that -- and maybe this isn't true for everyone, but for you, it's been an opportunity to do some things maybe that you otherwise wouldn't do. And I guess when --

Dr. Rick Patt: It's a brilliant observation.

Dr. Baile: When your time is limited, you cut to the chase sometimes in taking the bull by the horns, and you know, embracing things that you may have put off.

Dr. Rick Patt: Yeah, I feel like the cancer is really my ally right now. And I could list some of the -- first of all, you know, like many of us -- I'm a bit of a narcissist, and there's been a great outpouring of affection and love for me that I'm totally enjoying, and I'm just soaking it right up. And like I said, it's a good time. I'm focusing on things that are important for me and my family.

Dr. Baile: So, you know, when we talk about hope, I guess, while the hope for cure may not be realistic. The hope for reuniting with your family, of delving deeper into your music, of reengaging your friends, it sounds like it's something that can easily be overlooked and missed as, in a strange way, an opportunity that's created which you might otherwise have put off or not focused on.

Dr. Rick Patt: Yeah, I mean, you're right. We regard the idea of surrender as kind of a dirty word. But look what happens to the -- look what happened in Europe after World War II, you know. They got a lot of, a lot out of their surrender. You know, it's not all bad by any means.

Dr. Baile: Well, we hope to hear more about your journey today at noontime, and I want to thank you for doing this interview. And it's just great to see you again and talk about all of these things.

Dr. Rick Patt: Yeah, if it wasn't for being sick, I wouldn't be here. I'm very happy to be here, and if anybody can learn anything from what I've been going through, that would be very meaningful for me. I'm glad to be here, thank you.

Dr. Baile: You're welcome. So we've been talking today with Dr. Rick Patt about many aspects of his life, and most recently, his cancer diagnosis and how that has, in a way, transformed some of his life experience. And we invite you to also view the video of his lecture, which will be on the I*CARE website. Thank you.