For most medical students, there are few things more daunting than presenting a patient's case before senior physicians and peers. It was no different for David Johnson, MD, when, as a student at the Medical College of Georgia more than 30 years ago, he presented the case of one of his first and most memorable cancer patients.
"I remember the physician I worked with was a very professional and impressive man - the type who commanded a great deal of respect in any room," recalled Dr. Johnson. "So I made sure I prepared a presentation that was snappy and sharp."
The diagnosis of his patient: advanced lung cancer.
Dr. Johnson barely had a chance to get beyond the diagnosis before he was interrupted by his instructor. "He put his hand up and said, 'Stop. There's nothing we can do for this man.' And then the group moved on down the hall.”
After a brief moment of relief that the spotlight was off, Dr. Johnson recalls welling up with frustration - not because he couldn't give his presentation, but because there really was nothing that medicine could do for that patient.
Later that year, he confronted that feeling of futility again when his mother died of bile duct cancer. These experiences with some of the most difficult forms of cancer spurred Dr. Johnson's drive to specialize in oncology. And at a time when his peers eyed more "treatable" cancers, he opted to specialize in lung cancer research and treatment. "No one was quite interested in working on it, so the field seemed wide open for me to explore and make a difference."
After his residency, Dr. Johnson landed a position at Vanderbilt University, where he practiced for nearly three decades, eventually becoming the Director of the Division of Hematology/Oncology and Deputy Director of the Vanderbilt-Ingram Cancer Center. During his tenure, he helped lead research on the management of several forms of thoracic cancer and the development of new therapies. He also studied the biology and treatment of breast cancers, neuroendocrine tumors, and other cancers.
Then, in 1989, Dr. Johnson had another experience that shifted the course of his career: He became a cancer patient himself. After being successfully treated for non-Hodgkin lymphoma, he was initially reluctant to share this experience with his patients - preferring to keep the focus on their care.
"But after a few years, I slowly realized that this shared experience of facing a cancer diagnosis and treatment could be a positive for my patients," Dr. Johnson said. "I've found the mere fact that one of my patients was looking at someone who had cancer and survived is reassuring. It's like a brotherhood."
His experience also changed the way he cared for his patients for the better. "If you experience cancer yourself, you have a different perspective on how to discuss the realities of a cancer diagnosis and the effects it has on your life, in the short- and long-term," he added.
This perspective is especially useful when treating seriously ill patients. "Even when we as physicians cannot do much more for a patient than what we've already done, we can be there for them and be compassionate and humanistic," he asserted. "I've learned the best oncologists have this 'presence.' That is the essence of being a good oncologist."
Over time, Dr. Johnson has also become a strong advocate for cancer survivors. For example, he serves on the board of the advocacy organization LIVESTRONG, and he helped bring new attention to survivors' needs while serving as President of ASCO in 2004-2005 - the first cancer survivor to have that role. With more people surviving cancer than ever before, he is well-aware of the influence that the disease can have on a person's psychological, emotional and physical well-being.
Decades after his student encounter with advanced lung cancer, Dr. Johnson is thrilled to have witnessed advances in lung cancer care, even for patients with advanced disease. Doctors now have a growing arsenal of new treatments that target specific defects in the genes of cancer cells, and research is revealing better, more powerful ways to make use of traditional chemotherapy.
Equally important, he's seen advances in supportive care dramatically improve quality of life for patients with the disease. "In the early days of chemotherapy, when side effects were far more severe than they are now, we doctors often questioned whether or not the treatment was even worth it," he said. "Now we have solid answers. The therapies we use today have far fewer side effects and can actually cure the disease in some cases, and there's an incredible satisfaction in that."
Looking to the future, Dr. Johnson encourages new medical students to follow a path in oncology - and he envies the opportunities they will have to advance patient care. "It's the most interesting time in medicine, and opportunities in oncology are unbelievably exciting. If we keep going at this pace, who knows what advances we'll make?"
David Johnson, MD, FACP, is the recipient of the 2008 ASCO Statesman Award for his continued and tireless dedication to the American Society of Clinical Oncology, of which he was President from 2004 - 2005. He is currently Donald W. Seldin Distinguished Chair in Internal Medicine and Chairman of the Department of Internal Medicine at UT Southwestern Medical Center. His research interests involve understanding the biology of lung cancer and improving the treatment of this and other solid tumors. Since 2009, Dr. Johnson has served as an Associate Editor for Cancer.Net.
Last Updated: February 16, 2012