Michael Decker is an advocate of holistic medicine, which is why he works in the Center for Integrative Oncology in Richterswil. Traditional and complementary therapies are combined there. He is not afraid to speak plainly, nor to broach the subject of death.

What is integrative oncology?

Dr. med. Michael Decker: A bridge between classical medical oncology and selected complementary medicine methods. Complementary medicine is not alternative medicine, by the way. Rather, it works in a complementary way, i.e. in addition to something else.

What do you have against the term alternative medicine?

I have noticed that the public uses complementary and alternative medicine interchangeably. Alternative medicine suggests that alternative methods achieve something different from classical medicine. However, we try to combine the best of classical and complementary medicine.

Your website also mentions the keywords holistic, patient-centered, support from diagnosis to recovery or death. That sounds like palliative care!

Yes, of course (laughs). I believe that palliative medicine is also a holistic treatment that tries to understand a person on all levels. For me, holistic means treating the other person as if I were affected myself. I want to be perceived as a person, not be reduced to my illness, receive a clear diagnosis and a statement about my treatment. I want transparency and to be involved in the decision-making process as a responsible person.

"Holistic approach means above all good listening, good knowledge and has to do with the time factor."

What do you do differently from traditional oncologists?

I believe that many people in oncology today work holistically. Above all, this means good listening, good knowledge and also has to do with the time factor. If I only see the patient for five minutes, I'm probably less likely to do them justice than if I have a different time frame.

How long do your consultation hours last?

Initial consultations last at least an hour. After that, it depends on the regularity with which I see a patient and the situation they find themselves in. Is it a weekly follow-up or have you not seen them for six months?

What role do relatives play in integrative oncology?

A high one. The classic question at the initial interview is whether someone can bring their wife or husband to the interview. I always say: That's their decision. A holistic approach also means accompanying a sick person through a certain stage of their biography. Along the way, other people are also important. In addition to our patients, we also offer psycho-oncological counseling to the next of kin, such as wives. If they wish, they can also attend the appointments alone if the patients are unwilling or unable to do so.

How important is communication in your field?

Very important. For a person who is likely to receive a cancer diagnosis, there is nothing worse than firstly having to wait and secondly unclear communication. We try to prevent both. The clarifications should be quick, and we don't discuss important findings over the phone, but in person.

How do you deliver difficult news?

I address them at the very beginning of the conversation, in the first few sentences.

"Only part of what you say as a doctor in an exceptional situation sticks with the other person. You have to know that."

What do you say specifically?

I describe the findings and say it is a difficult or complex situation.

We know from studies that patients only absorb a fraction of the content in conversations with doctors. Are you hoping that people will still be attentive at the beginning?

As a medical professional, you should know that only part of what you say in an exceptional situation will stick with the other person. That's why this message needs to be clear and that's why I think it's good when relatives are involved in the conversation. It's difficult anyway if they only receive important information indirectly. I think it's good if at least four ears are listening in crucial conversations.

How does integrative oncology differ from palliative care?

Every doctor working in oncology has a large overlap with palliative care. However, this is often not clearly stated. Often, curative approaches are pursued with the aim of curing the disease, adjuvant therapy is used - i.e. chemotherapy is followed by surgery or radiotherapy - and investigations are carried out that do not reveal anything malignant. It's a completely different field there. But oncological diseases are often advanced and cannot be cured. We then talk about palliative treatment with the aim of achieving the best possible quality of life and controlling tumor-related symptoms. When patients read the word "palliative" in their copy of the discharge report, they regularly ask: Am I really palliative? In our everyday jargon, palliative care unfortunately means that it is already five to twelve.

"I emphasize that you don't do nothing anymore. On the contrary, we are still doing a lot, right up to our last breath."

How do you combat this prejudice?

I try to differentiate between curable and incurable situations in the conversation. I try to describe exactly what the tumor is doing, for example: an operation can no longer completely remove the tumor because it has spread to various places and has spread to other parts of the body. This puts us in a treatment situation in which we no longer pursue a curative but a palliative approach. However, this can also mean that the situation remains stable and lasts for years with a good quality of life.

What do you say when someone asks if he or she is going to die?

(thinks) I formulate as realistic an assessment as possible and communicate as openly and transparently as possible. But I also say that we are not good at estimating the moment of death. We have sometimes been very wrong. It is also important for me to emphasize that we are not doing "nothing more". On the contrary, we continue to do a great deal until our last breath.

What is your idea of death?

Most people think that death is not simply the end of a cellular structure, but that they live in completely different images. A young patient I accompanied said shortly before her death: "The illness will cause my body to die in the next few days. But I have learned that my being, which is what makes me human, remains intact.

There are oncologists who drop patients if they decide against further chemotherapy.

We also write on our website: from a single source and under one roof. For us, this means that the treatment team remains the same from the beginning of the illness to where the path leads.

They therefore see themselves as accompanying a person through their illness, regardless of the outcome.

Yes.

Isn't it sometimes almost scary how important you are to patients as a doctor, the god in white, so to speak?

(Laughs and looks down at himself) My T-shirt is blue! In certain, often critical situations, I am an important contact person. This usually has a time limit. Sometimes, a few years later, I meet relatives of a patient I have cared for closely and they ask me: How do I know you? That puts the whole thing into perspective.

"Incidentally, patients don't tell me: Palliaviva was with me. Instead, they say: Mrs. Irniger was with me."

What characterizes patients who choose integrative oncology?

These are people who are intensively involved with their situation and have important questions about their treatment. They often want to bridge the gap between conventional oncology and complementary medicine. However, we also have patients, particularly from the region, who opt for purely conventional oncology treatment.

You offer this second opinion consultation. Is this a marketing ploy or does it really meet a need? 

This is an increasing need, especially for new diagnoses and important treatment decisions. Some of our patients come to us from outside the region, for example from Ticino or central Switzerland. We also recommend that patients who have been diagnosed with a tumor seek a second opinion.

Now that the Paracelsus Hospital in Richterswil has had to close, can you still treat inpatients?

We run a practice here with a day clinic structure, so we can't treat patients as inpatients. We were able to do this before, although people from further away tended to choose hospitals closer to home. When they got better, they could come back to us for further treatment. Now we are trying to work more closely with regional and national hospitals, palliative care units and hospices. The closest ones are the palliative care unit in Affoltern am Albis and the hospices in Hurden and Feusisberg SZ.

What is your experience of working with Palliaviva?

Good and reliable for many years. We know each other. I know what patients need to be prepared for when they visit Palliaviva for the first time. That the nurses suggest a medication and emergency plan and that they take the time needed for a conversation. A strong relationship of trust often develops with a few carers. Incidentally, patients don't tell me "Palliaviva was with me" but say "Mrs. Irniger was with me." As the attending physician, I also find the personal contact pleasant.

The interview was conducted by Sabine Arnold from Palliaviva.