Dr. Pavel Boček – child oncologist and founder of a charity for young cancer patients
Dr. Pavel Boček is a Czech child oncologist who works at Motol hospital’s children oncology ward, sees patients in his own practice and has founded a charity for children with cancer. He also spent some time working in the United States, where he says he learned a lot about communicating with patients. For this edition of Czech Life, I spoke to Dr. Boček about his work, the field of child oncology and what first made him decide to go into that specific area of medicine.
How does the work with children differ from working with adults?
“It is a big difference; there are many periods in childhood: from infancy to adolescence, that is the first difference. The second is that a child cannot say I have a pain here, or there. So you have to be careful with the diagnosis, and also with the medication, because they are still growing so you can bring late side effects upon them. And a child has no idea what is going on, especially if it is a tumor, cancer, for them, the bad news is that they have to stay in hospital, so you have to work with the parents.”
The field of oncology is one of the medical fields where a lot of research still needs to be done, where a lot of questions are still unanswered. How would you say has the field developed since your time as a student?
“I started studying it in 1985 and at that time, the survival rate was around 40 to 50 percent, and today, we have a survival rate of over 75 percent. That is a huge progress and success. We can say that in the Czech Republic, around 350 children are diagnosed with cancer every year, which means about one child per day and we have child cancer care centers in Brno, Olomouc, Ostrava and Prague, whereas when I started, we only had one such center, in the capital. And for the most common disease, acute lymphoblastic leukemia, children are treated in their regional center. Of course, we also have new drugs, approaches, results from research, bone marrow transplants. Treatment is very aggressive and has improved a lot but we still have to be very careful to avoid side effects later in life.”
What in your opinion are the characteristics of a good doctor?
“That is a very difficult question, because I think that a good doctor has to have professional knowledge, be very good in his field, and be able to communicate with parents and children and be able to relate to them in a very special way. Not too distant, but also not too warm. He has to find a way in the middle, and to be a friend to the child. Especially in the cancer field, because the treatment can take years, so you do become a part of the family.”
Let’s talk about the time you spent in the US…
“In 1988, I asked some friends and they told me to try the Fulbright Fellowship. So I went to the commission and presented my plans, what I wanted to study in the States. Fortunately, I was chosen for the University of Minnesota, one of the leading universities in the children cancer medicine field. And so I was there for 10 months. There were three main areas: Of course, child oncology, the second was fundraising and the third was communication between hospital staff and parents and children.”
You have worked in both the American and the Czech medical systems. What are the main differences between the two?
“It is very difficult, in my opinion. If you are working in a very good university hospital, in the Czech Republic we do not have money for many activities or functions that are normal in the United States: ergo therapists, psychosocial workers, social workers, different categories of nurses, so there are a lot of other employees that are part of a team that takes care of child cancer patients. That’s the biggest difference.”
“If we compare the basic pediatric care here, that is absolutely excellent here, even compared with the European system. We have a very good, well-structured system of vaccinations and check-ups. So I think that is great. But in the adult medicine, there are some shortcomings here. In America, they face the problem of a huge number of people who aren’t insured, I think it is 15 million people. So there has to be some sort of reform of the health system.”
You say patient communication is a very important part of treatment. Could you explain that in detail?
“I feel that Czech doctors and nurses do not have time for good communication. I will tell you an example: In the US, during the morning check-up, they will say something like: ‘You have to get an x-ray for your lungs. We need to know if your lungs are clear. The results will be ready in the afternoon. Some of the injections you have been receiving could also affect your lungs, so we will be speaking about that.’ That is the normal way. In the Czech Republic, a nurse comes up to the patient and says: ‘You have to go to get an x-ray.’
“That’s it, no reason, no explanation why. We miss important facts of the importance of the daily communication between patients, nurses and the patients. So I still miss the sensitivity, a human way to explain why you are there, what we will be doing, what your diagnosis it and what we expect from treatment. Of course, there have been big improvements in many ways. But from my personal experience, many friends call me and tell me that their grandmother has been in hospital for three days and they don’t know anything. I feel that that is a big mistake.”
“Of course, you are right, in the beginning, it was very hard. I came home and was thinking about my patients, which was emotionally difficult. I tried to relax with sport and music. But when you come to a patient, you have to be involved in their suffering, listen to them and help them. Some people say you have to be strictly professional, but I disagree, you should be slightly emotionally involved. I became friends with some of the parents whose children died, who did not respond to treatment, and of course, there are those who survived and now come to visit me at the hospital with their children, and that is great to see.”
You also founded a charity – sluneční paprsek pro děti, or a ray of light for children. Could you describe what your charity actually does?
“I was inspired by what I saw in the States, summer camps for children with leukemia. They played games, fighting leukemia cells like Indian warriors etc. And I thought to myself, we save many children, but what do they do afterwards, when they have to return to their regular life? They have missed school for a few years; have not seen their friends a lot. So the idea is to invite children to this summer camp two or three years after cancer treatment, and because we do not have a sea here, we take them to the beach and we play, play, play. There are doctors, psychologists and physiotherapists who come along, so there is some medical element to it, but it is also a chance to make new friends.”
“We would like to get more children in our hospital that can be saved, because sometimes, they are still misdiagnosed and get to us very late on in the process. So I hope the number of those children will be decreasing. As for the charity, we have a big concert on December 17, and March 20, we are organizing a big exhibition with some American artists to collect more money so we can take more and more children to the sea.”
