QOL FastBlast!: Would You Rather Be A Victim or a Secret Agent?
It's not just semantics.
This will likely be a short post. but still an important one to me.
It regards some terminology used by a large swath of the medical community (though not completely). It’s the language surrounding when a patient has some weird stuff going on but nothing concrete enough to take treatment action. In short, a medical team opts to keep an eye on the situation at regular intervals and gather more info. This means things like scans (via MRI or CAT imaging) and blood labs. If things get worse, then action is taken in accord with whatever has been learned. If things stay the same, then more tests… ummm later.
This is commonly called “Watch and Wait”. Some use “Watchful Waiting” but come on, that’s just too zen master psychobabble for me to accept so let’s ignore it altogether for the purposes of this post. I mean, it’s terrible.
You can find a more formal definition (ie BORING AND DRY) of “Watch and Wait” and other phrases at the NCI Dictionary of Cancer Terms linked here. The NCI site is a really great resource if you have a basic grasp of health stuff from a clinical standpoint or are a member of the professional medical community, but not so much if you’re a mere mortal. It’s lacking a lot of stuff us cancerfølken actually use in private conversation but it’s a decent start.
As mentioned earlier, not every medical professional uses this term (again, we’re ignoring “Watchful Waiting”), but I personally feel strongly that it needs to change universally. And while the phrase may not seem like a big deal upon first consideration, it is.
The reason? I get that it means that it technically means “operators are standing by” to handle any issues, but from the patient perspective, it feels lazy and the opposite of instilling confidence. Think about it… you get a tip there’s someone… or something… out to cause serious harm to you or some people you care very much about. So you call law enforcement… the people who you believe to be the ones to protect you and yours… and they tell you “No worries. We’ll keep an eye on it— ya know send a patrol car by your home or something so it’s all good.” I know that’s not really what “Watch and Wait” is, but it feels like that to many patients.
Patients want to feel like they are somewhat of a priority and that their doctors know what they’re doing. Deep down, we all may know that this just isn’t 100% possible with the demands of patient load and the limits of specific scientific knowledge, but can we at least pretend like there’s more control to be had when it comes to cancer? “Watch and Wait” just feels like “hold on… we just don’t know what to do” instead of the build-up to a massive RICO case arrest and prosecution scenario. It’d be one thing if someone had a fairly rare or unique situation to use a phrase like that, but this protocol is pretty dang common in the cancer world. Sure, it beats going straight to chemo and/or radiation from surgery, but there is a better way to handle this sort of situation without it feeling like you’re waiting for your number to be called when the shit inevitably hits the fan. Maybe the proverbial “shit” will never come, but that verbiage feels a lot like like that’s what’s gonna happen. And no one wants to do anything about the “shit”… at least not just yet.
I’ve written previously about scanxiety, the phenomenon of increased emotional stress between scans and other tests. Do you think anything about “Watch and Wait” helps reduce it?
So what to do instead? I didn’t come up with the phrase, but I’m voting to permanently replace “Watch and Wait” with “Active Surveillance”.
When I first heard it, I knew instinctually that it was perfect. I mean, it feels like you’re part of a spy mission or military reconnaissance… but without getting too ridiculous about it. I personally don’t mind ridiculous medical terminology. In fact, I kinda find comfort in it, but I know not everyone is like me.
Even if there is nothing procedurally different about what happens within this treatment algorithm, I personally believe it’s a good thing for both patients and the medical community.
Instead of going into routine tests and scans with Average Joe or Average Jane Smith (nice people and all that), the patient is undergoing deep testing with Agent Smith to takedown any evildoers. The patient not only feels involved and cared for, but like they are part of this mission. Medical staff are also elevated in status to the patient. The medical team goes from showing off the machines that go “ping” to actually knowing how to use them to make a difference sooner than later.
Again, I get that nothing is procedurally different but it still feels like an easy win to make everyone feel better about it all. So why not?
Language matters a lot more than most people think, and reframing something like this can make an enormous impact on how things go in the future. Of course, I'm super biased as an etymology dork, but bias notwithstanding, I think this is a useful reframe.
It's funny how the human mind works, right? Because I fully agree that hearing "Active Surveillance" instead of "Watch And Wait" sounds so much more energetic and proactive.
As a semi-related side note, I've heard many foreigners complain about Danish general practitioners because of their seemingly laissez-faire approach. Danish doctors are less trigger-happy when it comes to prescribing treatments, which isn't in itself a bad thing, but that's why they often come across as indifferent or passive.
I wonder if they could change that perception by calling their non-intervention strategies something more badass, like "Ambush Prepping" or "Stealthy Decoy"