“I can’t thank you enough for your help.”

This gratitude from a cancer survivor surprises me since I recall doing little of the sort.

Some years ago, the young professional was in the throes of seeing multiple specialists, their advice strewn like confetti in her ordered life. Under pressure, she was calm and methodical. What impressed me most, however, were her astute questions. Why did she need such a major operation? How did gene testing matter? How much chemotherapy was enough? How could her voice be heard?

Every doctor knows to avoid a gratuitous second opinion without reviewing the evidence and, importantly, the person. Quietly, I found the plan aggressive and ill-explained but I simply urged her to nail down answers to her questions that were not merely academic but highly consequential. Then I crossed my fingers.

Now, I uncross them as she reports having undergone a much smaller procedure thanks to her persistence. I know all too well the potential damage she escaped through being educated, empowered and unafraid to challenge her doctors, which reminds me of my average patient who is so disadvantaged, disempowered and frazzled that there is a heavy reliance on “the system” to get things right.

In one of the world’s richest countries, every cancer patient should expect equitable care delivered by excellent clinicians informed by the best evidence. But the further patients live from a metropolitan cancer centre the more likely they are to die within five years of their diagnosis. Add to this the disparities in outcomes due to language, Indigenous........

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