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his own experience as a patient. It was published in the journal of American Medical Association and also in a little book. The last sentence in that book says: “In essence, the secret in the care of the patient, is in caring for the patient”. That is so important. When I first see a patient to evaluate him for surgery, I believe that the healing begins that day. The first thing I do is find a common interest, something we share. I let them see that I am very accessible to them and that I am very interested in them. All of a sudden, they realize that they have a doctor, who cares for them. That matters more than anything in the world. Some doctors have a fellow who evaluates the patient, and afterward they walk in the room and point their finger saying: “Yes, he can have surgery. Sign him up.” Those patients are robbed of that very important experience. So, remember, the secret in the care of the patient, is in caring for the patient.
F.N.: In one of your previous interviews,
you have mentioned a quote of Albert Einstein that says “Those who travel with the crowd usually get no further than the crowd, but those who walk alone oftentimes end up in places that no one else has been before”. Oftentimes is difficult for a young doctor to “walk alone and away from the crowd”. How did you manage
to step outside of the crowd, think outside the box and make all these discoveries?
P.W.: I listen to my patients. If a patient asks me a question and I can’t find the answer or tells me something that sounds incorrect, maybe they are correct and I am wrong. It’s like the first patient, who told me that he was potent. So, if you find a patient who tells you something like this, this is maybe your opportunity to walk alone.
T.S.: We have heard you many times emphasizing on how important is it to listen to your patients. How have your patients helped you so far into developing your significant contributions to Urology and prostate cancer diagnosis and treatment?
P.W.: It’s been the secret of my success in so many things. I have two examples. (9) That patient who was potent. As soon as he told me I instantly knew that the nerves did not run inside the prostate. I didn’t have to do a statistical study. This initiated my journey into looking for the nerves. Everyone thought I was crazy.
My friends would come up to me and say: “Walsh, do you really believe you can preserve potency? You have lost your mind!” That is how impossible it seemed. Another good example occurred shortly after PSA testing came along. Prior to PSA testing, we only did a needle biopsy when we felt something. After PSA testing became available, we began doing biopsies on men with normal feeling prostates and began discovering some very small cancers that didn’t need to be treated. I remember such a patient who said to me “Doctor, how much cancer is in my prostate?”. I paused and I said ‘’Well, if there is one needle in a haystack there are probably more.” But I was very disappointed with that answer. So, I went to Dr. Epstein, the famous pathologist at Hopkins, and I said: “Let’s go back and look at all the cases that I operated on, and find the ones where there was a very tiny amount of cancer, and see if we could have predicted that.” It was from that investigation, that we discovered the definition of very low risk prostate cancer, which is used today as an ideal criterion for advising active surveillance. (10)
If you listen to a patient who asks you a question where you cannot find the answer or tells you something that sounds wrong, this may be your opportunity to make an important discovery and walk alone.
Tεύχος 27 | Iανουάριος - Φεβρουάριος 2024
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