Bernie S. Siegel defies the stereotype of a conservative, traditional surgeon.
He encourages patients to call him by his first name.
He strongly suggests that physicians spend some time as hospitalized patients, lying flat on their backs hooked to intravenous lines. (He has.)
And he firmly believes patients should be rule-breakers, questioning their doctors and their treatments and--most importantly--sometimes focusing more on what's wrong with their lives than with their bodies.
Patients who break the rules--or exceptional patients, as Siegel prefers to call them--can sometimes beat killer diseases like cancer, he claims. And even if they don't beat them, he says, they learn how to get more out of the days they have left.
Siegel, a 54-year-old assistant clinical professor at the Yale University School of Medicine and a New Haven surgeon, describes dozens of exceptional patients in his book "Love, Medicine & Miracles."
There's Louise, an independent teen-ager diagnosed with cancer of the ovary, lungs and abdomen, given a year to live. Instead of undergoing the recommended chemotherapy treatments, she left a stressful family environment, got her own apartment and began helping other cancer patients. On the day she was supposed to have died, she sent her doctor a note: "Where should I send the casket?" She is still alive.
Lois, diagnosed with breast cancer during her second pregnancy, underwent a mastectomy, learned to meditate and to put herself first. She gave birth and went on to a remission of six years.
Like several of his colleagues, Siegel suggests that techniques such as imagery, meditation, hypnosis and a good attitude coupled with competent medical treatment might aid in healing.
The American Cancer Society agrees "that a positive mental attitude, psychosocial techniques and support are important for improving the quality of life for cancer patients," but in 1985 it took the position that evidence does not support the theory that stress reduction can change the risk of cancer or the duration of survival. The society does not, at this time, recommend the use of psychosocial intervention to alter tumor growth or spread.
Siegel's book, which explores the links between attitude, disease and healing, was published last year by Harper & Row and zoomed to No. 1 on the New York Times best-seller list after his appearance in March on the Oprah Winfrey TV show. This week, 11 printings and 210,000 copies later, the book is still No. 9 on the New York Times best-seller list and has been listed for 13 weeks.
Although everyone has the potential to be an exceptional patient, Siegel said during a recent interview in his Beverly Wilshire Hotel suite, only about 20% live up to that potential. The majority--60%--perform to satisfy their physicians, and the remaining 20% have a conscious or unconscious wish to die, he said.
Exceptional patients don't win many popularity contests with their mainstream physicians, Siegel emphasized. "These are patients seen by the health-care professional as difficult patients, ones with whom they often have poor relationships. They're the ones who want to know why they're having all these tests done. They're never in their hospital rooms. They disrupt the system (because) they're fighting for their identities.
"Exceptional patients are fighters, but they also have a spiritual component to their lives. They can say, 'Look, God, I can't take care of this one, you'll have to handle it.' "
Discovering the concept of exceptional patients was an outgrowth of his own disenchantment with traditional medicine, Siegel said. Nearly a decade ago, he began feeling unsuccessful as a surgeon.
"You go to medical school and they fix you good," Siegel said. "They don't let you meet people for a few years, so you're disease-oriented. And they say, 'Don't let anybody die. So you're immediately a failure (when a patient dies). They said, 'Cure everybody' and I said, 'I can't.' "
Siegel began looking for alternatives to traditional medicine. Among other avenues, he explored the teachings of Dr. O. Carl Simonton, now director of the Simonton Cancer Center in Pacific Palisades and a pioneer in the use of imagery to fight cancer.
In a symbolic effort to uncover his own emotions, Siegel said, he shaved his head. (He's kept up the habit partly because his daughter Carolyn says it's easier to find him in the movies.)
Listen to Patients
And he became convinced of the importance of listening to patients--and of the powerful blend of positive thinking and modern medical technology.
In 1978, Siegel and his wife, Bobbie, set up Exceptional Cancer Patients (ECaP) in New Haven, Conn., a support network that includes specialized group therapy and individual therapy to ease personal change and healing.
Siegel poses four questions to these and other patients newly diagnosed with a life-threatening illness: Do you want to live to be 100? (Most patients, Siegel said, won't answer affirmatively without some guarantee of health.)