Robert Roth, DO, FACEP, is a soft-spoken Southern gentleman whom many of us know from the ACEP Council, where he has been a fixture for many years. He was a stalwart on my steering committee when I was Council speaker, and so I was absolutely delighted to learn that he would receive the 2013 Council Meritorious Service Award.

Dr. Roth began visiting the Wellness Booth at ACEP’s annual meeting soon out of residency in the early 1990s. He had a physician on paper (for insurance purposes) but really had not accessed medical care for himself. It seemed a good investment (especially because the booth was free in the beginning) to have a screening of his general health status, including blood pressure, body fat, and metabolic and other blood baseline testing. So, like many healthy fellow members, he used this as his entry point into the medical system. He would visit every other year or so and would alternate between optional blood screenings for hepatitis titers and prostate-specific antigen (PSA). Everything seemed fine, and he said he picked up useful health information as well as a sense of emotional well-being from visiting the booth, manned by ACEP colleagues interested in optimizing wellness.

Dr. Roth received a moderately aggressive form of treatment that has been successful with minimal side effects, and his PSA levels have fallen back to below his baseline (normal) levels.

A Red Flag

After several years of PSA testing at the Wellness Booth, Dr. Roth noticed a doubling followed by a more rapid rise in his PSA levels, which were still low but troubling enough that he consulted a physician back home who decided to send him to a urologist “just to check things out.” Even though he was not too concerned, this physician did further testing and felt it might be wise to biopsy several areas. The biopsy revealed a moderately aggressive tumor in one quadrant. Along with two colleagues at a local hospital, the urologist sat down with Dr. Roth and his wife and laid out all of the options so they could decide how to approach the problem. After performing obsessive research on the condition (like all physicians who find themselves with a potentially serious diagnosis) and becoming thoroughly confused and frightened in the process, Dr. Roth found this meeting to be an enormous gift that allowed him and his wife to relax and trust that someone else was handling the case expertly, while allowing them to make the decisions that would most directly affect them.

Dr. Roth received a moderately aggressive form of treatment that has been successful with minimal side effects, and his PSA levels have fallen back to below his baseline (normal) levels. Now he gets yearly checkups with his “real doctor” and will celebrate five years of being cancer-free in August.

Lessons Learned

Dr. Roth has always been a calm and thoughtful person, but he feels this experience has taught him many valuable lessons. The first is that he is no longer Superman and that there will be times in his life and situations he cannot control (very valuable lessons for an emergency physician!). Another is that it is necessary in such a situation to pick someone and trust that person with your health. Most physicians feel enormous relief when they can relinquish the self-diagnosing role (and thus stop being a fool) and get a “real” doctor who will give direct answers to difficult questions with no hesitation and no holds barred. He learned that you must be willing to call for help and to be aggressive when your health calls for it. “All we have,” he said, “is time, and we need to use some of this time in order to safeguard and maximize our health.”

Another lesson is that he has friends in unexpected places and can talk frankly with them about difficult topics. A local colleague, another emergency physician with metastatic prostate disease, was incredibly helpful to him in sorting through emotions and options when he was first diagnosed.

As a result of this experience, Dr. Roth feels he can relate better to patients and is able to address significant problems with them (even very serious initial diagnoses such as leukemia or lung cancer) more calmly and frankly, having the benefit of a bigger picture and with a more organized approach to model for them (though this is a challenge in a productivity-based system).

He loves going to work every day because he knows he has something to offer both patients and colleagues, especially younger ones. His most valuable skill, he believes, is his ability to be straightforward with everyone. Although this comes to him naturally, it has become easier with age and this experience, and he tries to pass it on.

Dr. Andrew is a past ACEP Council Speaker, chair of the ACEP Well-Being Committee, a senior member of the Medical Legal Committee, and the editor of LegalEase. She is a founder and past president of the Coalition and Center for Ethical Medical Testimony and the principal of www.MDMentor.com, which assists physicians dealing with medical legal issues.