Recently, a previously healthy young man came to see me. The resident who had seen him first came out of the room and said that he was focused on alternative therapies. When I walked in, the patient was alone in the room with a family member on the phone. He had been recently diagnosed with a cancer that was very curable but that would require a significant amount of chemotherapy to treat. Without systemic therapy, the chance of death was high.

The patient was clearly anxious—tachycardic and having a hard time making eye contact. He said that after his diagnosis and initial surgery he quit his job to focus on treatment, and he has spent some weeks researching his disease and options. As I began discussing my recommendations, trying to sound both optimistic and as clear as possible, I became quickly aware that he was very skeptical of chemotherapy.

He opened his notes and began to ask questions: can we sequence his DNA to determine the best drugs to use; where is chemotherapy derived from; he is already taking ivermectin—would I be fine with him continuing it; he has purchased immunotherapy in intramuscular injectable form and is about to start it and would like to give it a chance; could I sign off on a form for hyperbaric oxygen to starve the cancer. Some of the questions were very reasonable and well-thought-out, but others sounded like they came from a misguided AI apparatus—a hint of truth mixed with confusion.

I had other patients waiting, and after close to an hour of answering question after question, I felt my own anxiety rising. How do I align his concerns and beliefs with what must be done to save his life? How do I communicate with someone whose worldview was clearly very different from mine and the traditional oncologic establishment? How do I build a level of trust to allow us to move forward and avoid the risk of having him not return for any treatment at all? And how do I do all that without spending hours in the room?

In oncology, the use of complementary and alternative medicine is common. Patients frequently do not tell us what they are doing or taking at home, but often these actions are safe. Sometimes, however, this is taken to an extreme and can cause serious harm.

I am part of the ASCO Ethics Committee, which is currently working through a framework meant to help conceptualize how to deal with patients in cases like this. The questions include how to work toward shared decision-making, how to preserve trust while remaining curious and empathetic, how to respond proportionally to various requests and situations that may ask us to bend our beliefs, and what are the ethical implications of these interactions.

I find that the best way to resolve the tension in situations like this is not always clear, and I think there is not one universal solution. My approach is typically to negotiate, empower, and engage patients and family members to develop trust that will then allow us to move toward the right solution.

My patient did come back and started treatment, but this case reminds me how drastically differently humans can see the world, how our values and beliefs can be fundamentally different, even regarding what is seemingly scientific and clear cut. Being reminded of how the information deluge we live in can sometimes muddy the waters can also teach us to remain humble and human, and remind us how scary it is to sit on the exam table.