It’s one of the most common questions asked by patients with cancer, but also the most difficult: “What would you do if you were me?”

Monash Health medical oncologist Dr Mahendra Naidoo says it's a question that tests the limits of empathy and evidence – and one he thought he understood. That was until his colleague, a veteran gastrointestinal oncologist in New Zealand, was diagnosed with the very disease he had spent decades treating.

“It's a question that many of us think we have an answer to,” Dr Naidoo  says, “but until that diagnosis is given to ourselves, we can’t really know.”

In a very personal and reflective JAMA Oncology piece titled  The View from the Other Chair – An Oncologist’s Journey on Becoming a Patient, Dr Naidoo captures his conversation with Dr Dragan Damianovich – “Dr D”, a senior clinician diagnosed with stage IV pancreatic cancer.

The interview, conducted shortly before Dr D’s death late last year, has since resonated deeply within the oncology community – a rare and unflinching look at what happens when the physician becomes the patient.

When the question becomes personal

“It was one of the most unbelievable privileges of my professional career,” Dr Naidoo says. “He was grounded in evidence and respected for his wisdom. He pushed for the scan that confirmed his fears. The man who had interpreted innumerable scans now stared at his own – locally advanced, inoperable.”

When the diagnosis came, preceded by a new diagnosis of diabetes and then unexplained weight loss, he approached treatment pragmatically.

“I am led by evidence,” he told Dr Naidoo. “If a certain regimen has been published, why would you not believe it?”

He opted for full-dose FOLFIRINOX, the intensive chemotherapy program of four drugs he had long prescribed to others, based on a 2011 trial. But his body, he later admitted, “was not a clinical trial”.

Rethinking toxicity, redefining quality of life

On paper, his oxaliplatin-induced neuropathy, a side-effect, was grade two – a moderate toxicity. In reality, it was crippling.

“Technically, it’s a grade two,” Dr Naidoo says, "but in terms of quality of life, it's much worse.”

It was an admission that caused him to “mentally replay” every conversation he’d had with his own patients about toxicity and what he’d told them was “manageable”.

“I realised our toxicity grading is so generic,” he says. “It doesn't capture what it means for the individual – whether someone's a violinist, a builder, a grandfather. We underestimate the impact of toxicity on quality of life. 

“We need to recognise it better, and do more to mitigate it. Do more to understand what toxicity means to each patient.”

Rethinking evidence, redefining hope

Despite his symptoms, Dr D kept his routines, describing fatigue as a “vicious circle” that must be actively resisted.

As a patient, he spoke about the limits of clinical detachment, and the value of complementary, evidence-aligned care, an approach Dr Naidoo wanted to platform.

“Complementary medicine is such an elephant in the room – patients often ask about vitamins, supplements, nutrition, all sorts of things – and so this was something I really wanted to explore.”

When he asked Dr D, a physician he says was known for being a “purist”,  whether he'd gone down that road himself, Dr Naidoo says he was surprised by the answer. He supported the integration of wellness support into standard cancer care, stressing that specialist allied health professionals, rather than physicians, are best-suited to advise patients on such approaches.

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Dr Naidoo says those admissions revealed a humility that often eludes clinicians, adding that patients need to be given space to talk about complementary medicine as part of their care.

At the heart of their discussion was hope – a concept that had underpinned Dr D’s practice for decades, one that he wielded with “clinical precision”.

“I tried to concentrate on positives,” he told Dr Naidoo. “I would mention those positive experiences rather than the negative with my patients,” speaking also of the long-term survivors – the “statistical outliers held up as beacons”, as Dr Naidoo explains  it.

But, Dr D admitted, while he thought he understood hope as a doctor, as a patient, he realised he hadn’t.

Still, when asked whether his diagnosis had changed his view on the power of hope, he replied: “No. It has even strengthened it. Because I think with these cancers, that's the only thing you have left.”

But Dr D remained characteristically pragmatic when asked what advice he would give to a newly-diagnosed patient, says Dr Naidoo.

“Sort out your affairs from the very beginning. And try not to interfere too much with your treatment. Trust the team you've chosen.”

What oncology carries — and what it costs

He also issued a warning to younger oncologists about burnout. 

“We are burnt out,” he said. “You need to think about work-life balance much earlier. As oncologists, we’re constantly immersed in highly emotional situations, but we don’t do enough to look after ourselves psychologically. It’s not just about eating well or exercising – it’s emotional and mental wellbeing.”

He described oncology as an “outlier” specialty, closer in spirit to palliative care.

“Before I started oncology training, I did six months in hospice as a registrar, and that was one of the most formative experiences of my career,” he recalled.

Read more: Cancer and heart disease: Out of the frying pan and into the fire

One thing palliative care does well, he added, is clinical supervision – protected, funded sessions where clinicians can debrief regularly with a psychologist. He said he thought it should be mandatory in oncology.

“Burnout rates are high, and we need structured ways to process what we carry.”

For Dr Naidoo, the conversation – and the trust Dr D placed in him – has reshaped his professional compass, changing how he approaches toxic side-effects, communication, and hope.

“In the immediate aftermath, I realised how important communication is."

Hope, revisited

He’s started attending advanced communication workshops for consultants, which help structure difficult conversations, particularly those where clinicians are faced with having to tell patients there are no further treatment options or that a therapy isn’t funded.

“I’ve learned that there are better ways to do this – to avoid patients feeling abandoned. And I’ve become more deliberate about discussing hope. That was the central theme of our conversation – how hope changes meaning over time. 

“What hope means today isn’t what it means in a year, or even a week. I’ve started talking about that more openly with patients, even when options are limited.”

This article was first published as “How my colleague's cancer journey reshaped my practice” in The Limbic, written by Sunalie Silva.