What breast cancer taught me

At St. Michael’s, patients are empowered to teach medical students about what it takes to be a better surgeon.

What breast cancer taught me

In 2015, Emily Piercell found a lump in her breast. She was 27 years old, newly married and a law student living in southwestern Ontario. And while her family doctor did send her for tests, which all came back negative for breast cancer, she felt like she wasn’t being heard.

“I was told I was too young to get breast cancer. ‘It’s not in your family, it’s not breast cancer. You just have dense breasts,’” she recalls hearing.

Three months later, the tumour had tripled in size.

“The look on my family doctor’s face, she knew something bad had happened,” says Piercell.

This time, her doctor sent her to a different hospital. She got a biopsy, thanks to a technician who pushed for it.

“The radiologist almost didn’t biopsy it and almost didn’t come into the room because the ultrasound looked normal again, but the technician really fought for me.’” The biopsy result? Stage three, triple positive breast cancer that had spread to her lymph nodes.

Piercell moved to Toronto for treatment. Today, she’s an advocate for patients like herself.

“Young people do get cancer. I’m not unique in my diagnosis story,” she says.

She found the right spot to bring about change. It’s a program called Patient as Teacher, and it’s at St. Michael’s Hospital.

Dr. Jory Simpson, a breast surgical oncologist and division head of general surgery at St. Michael’s, launched the program in 2017.

Patient as Teacher brings together cancer patients like Piercell and surgical clerks in their third year of medical school in workshops where patient-teachers share their stories to explain what it’s like to be a patient and how surgeons can make the experience better, outside of the operating room. The program is expanding to more students, and other universities.

“The problem with the surgical clerkship is that the medical students only see pieces of the patient’s surgical journey,” Dr. Simpson explains. “What often happens is they’ll come into the operating room and see a patient. They do not know the patient and will never see the patient again. So they’ll have no appreciation of the impact of a breast cancer diagnosis.”

Trained facilitators guide the conversations, and there are no faculty present in the patient-teacher sessions. This way the patient-teachers feel free to share the good and the bad with the medical students about their experiences. And the students get advice from actual patients about a scenario they’re grappling with and what they could do differently. The goal is to help students become better doctors by learning to really listen to patients, communicate with them, and include them in the decision-making.

“Patients are experts in their illness and we need to learn from the experts,” says Dr. Simpson.

The program also empowers the patient-teachers. “They feel like they’re giving back to the health-care system and part of their healing process is to share what they have gone through with the next generation of physicians. So they think it adds purpose to the disease that they have survived,” Dr. Simpson notes.

Piercell, who is now the program’s coordinator, agrees. “It flips the usual power imbalance. We get to say, ‘Well, I’m going to teach you something today.’”

As for what she likes to teach the students? One of the stories Piercell shares is about the day of her mastectomy.

“My surgeon was amazing. She held my hand while I was crying and falling asleep. Instead of making this awful day even worse, she had such empathy and compassion. I want the students to know that something so small as giving me space to be sad about losing my breast makes a huge difference. And it’s a little thing that they can do.”

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