Communicating the intricacies of oncology care to vulnerable patients with cancer and their caregivers requires a firm grasp of the nuances of language. One of the oncology community’s true champions in the art of breaking down communication barriers is Lidia Schapira, MD, a medical oncologist at the Gillette Center for Breast Oncology at Massachusetts General Hospital and Associate Professor of Medicine at Harvard Medical School, Boston.
Dr. Schapira was born and reared in Buenos Aires, Argentina. Her father was an Austrian physician who fled to Argentina to escape the Nazis at the beginning of World War II. “My father was probably the wisest and kindest person in my life, and I strongly identified with him,” said Dr. Schapira. She remembers running to the scene of an accident when she was just 5 or 6 years old to see if she could help. Perhaps Dr. Schapira’s decision to follow in her father’s medical footsteps was subconsciously preordained.
After graduating high school, Dr. Schapira said that her academic options at the time in Buenos Aires were fairly limited. “I actually wanted to study philosophy, but my father suggested that I should first get a real profession, then I could philosophize all I want,” said Dr. Schapira. A career in medicine was not only real, it offered Dr. Schapira an opportunity to satisfy her intellectual and scientific interests while fulfilling her desire to give something back to society.
Dr. Schapira said that she was drawn to the special challenges offered in oncology. “I loved problem-solving, and two areas of medicine that offered that challenge were infectious diseases and hematology. I also thought of pursuing psychiatry, but there just wasn’t enough action there for me. So I chose hematology, which was tied to the hip of oncology. Once I finished my medical training, I found oncology was a natural fit for someone also interested in psychology. It allowed me to care for patients with cancer and find out how they emotionally dealt with their illness,” explained Dr. Schapira.
Dr. Schapira went to the University of Buenos Aires School of Medicine for 3 years, and then transferred to Dartmouth Medical School, receiving her MD in 1982, after which she trained in medicine at the Beth Israel Hospital in Boston until 1985. She then took a “gap year,” working in a community hospital until 1986, when she entered a hematology fellowship at Brigham and Women’s Hospital. It was there that her interest in doctor-patient communication began to take form.
“I was fascinated to learn how patients experienced day-to-day chronic illness, from diagnosis through the continuum of care. I remember asking my program director if there was a way I could study how patients reacted to hearing the news that they had a disease like leukemia. He gave me a puzzled look and told me that no such area of study existed,” said Dr. Schapira, adding, “It was sort of the same reaction I got from my father when I told him I wanted to pursue a career in philosophy.”
“After fulfilling all the requirements, I became a card-carrying hematologist/oncologist. Although I enjoyed the scientific component of oncology, I still didn’t have a clear vision about my career path. This period of indecision coincided with two major events in my life: My father died, and my first child was born,” said Dr. Schapira.
With a new baby at home, Dr. Schapira went on a self-described part-time track for about a decade, during which her practice began to focus on patients with breast cancer. “I also kept the academic piece of my career alive by doing a lot of teaching. But I juggled my career to maintain a presence in my home life, which was very important to me,” said Dr. Schapira.
She continued, “Although I was very organized in both my home and professional life, what I didn’t anticipate was that the emotional aspect of caring for patients with cancer was impossible to separate from my personal life. I spent many years cultivating my knowledge and skills in communicating with patients about their deepest concerns as they went through cancer treatment,” said Dr. Schapira.
“During those transitional years, an opportunity developed through a patient of mine, a lovely young women who was dying of breast cancer. We became friends, and largely because of our relationship, I dived deeper into the dynamics of the doctor-patient relationship in the setting of cancer and other life-threatening illnesses,” said Dr. Schapira.
Her patient’s name was Julie Goldman. “We made a short film exploring how Julie’s diagnosis of cancer affected our own relationship. The film is called ‘One Story, Two Voices’; it is still available and continues to be used for medical and nursing education. It highlighted the opportunities for collaboration between cancer patients and their oncologists so that the relationship itself had therapeutic potential, regardless of the outcome of treatment,” said Dr. Schapira. “We gave lectures to draw attention to the lost potential that exists within the doctor-patient relationship. We were showing the community how better communication skills can translate into better clinical outcomes, using support groups and other methods of shared communication.”
In 2002, Dr. Schapira became more involved with ASCO and other cancer organizations, developing innovative curriculum for postgraduate medical education and led workshops designed to improve the knowledge and skill set of clinicians. “Cancer organizations such as ASCO gave me a more formal venue to help train physicians in the skills that help them respond to and communicate better with their patients,” said Dr. Schapira. She also became more involved with the advocacy community, seeking to find better ways to integrate and strengthen the bond between patient groups and professional organizations.
Return to Academia
As Dr. Schapira’s children became full-time students, she was able to return to academia, which gave her the venue to research and pursue her interest in the art of oncology communication. “As I learned more, I began to foster educational programs about what we now call the ‘patient experience.’ These initiatives raised awareness among the scientific and clinical communities about the need to treat cancer from diagnosis to the last breath in a way that really pays attention to all the complex needs of the patient,” she stressed.
Dr. Schapira served on the Board of Directors of the American Psychosocial Oncology Society (APOS). She described her work with APOS as a natural extension of her ongoing work in the field of communication. “We share a common interest in advancing the science of oncology and disseminating the important message of caring for the whole person, not just the disease,” said Dr. Schapira.
At the 2011 Annual Meeting, she received ASCO’s Statesman Award for her years of extraordinary volunteer service, dedication, and commitment.
As a communication specialist, Dr. Schapira has also branched out into the challenging field of medical interpreters—professionals who play a crucial role in mediating language-discordant encounters between patients with cancer and oncologists. “I grew up in a multilingual family. And because I immigrated to the United States, that helps me relate to patients from other countries who might feel like outsiders. The nuances of different languages truly affect conversations that involve clinical life or death decisions,” said Dr. Schapira. “So my work in this area is dedicated to demonstrating to the oncology community the importance of really paying attention to language preferences of our patients.”
Dr. Schapira considers her work with medical interpreters a calling, bordering on a labor of love. “I feel that I have made a solid contribution in elevating the standards of professional medical interpreters. To that end, I convened an NCI-sponsored retreat of professional interpreters from all the NCI-designated cancer centers. For 2 full days we discussed ways to standardize the practice of medical interpretation and raise the level of specialized interpretation. The terminology in oncology exceeds the knowledge of most interpreters, and this kind of intervention can make a huge difference in the quality of care we deliver,” said Dr. Schapira.
Asked what she does to decompress from such a challenging career, Dr. Schapira responded, “If I have time, I’ll get in an early morning workout. But having quality time with my family is most crucial. I still have one child still at home and if I have time to see him in the morning before going to work, that’s a good day. Then there’s my 4-year-old golden retriever, Teddy. I walk him every morning, which is a great way for me to start my day.” ■
Disclosure: Dr. Schapira reported no potential conflicts of interest.