A frequent and fundamental failure in communication

An interesting article on the Medscape web site this week is entitled, “Tough talks with cancer patients: dealing with challenges.” The article (by Shelley Reese) is primarily about how medical oncologists need to deal with such “tough talks” (i.e., “I need you to understand that you have been diagnosed with metastatic prostate cancer, which is not curable”). However, in the opinion of The “New” Prostate Cancer InfoLink, much of the article is equally applicable to many of the conversations between urologists and their prostate cancer patients as well as to those between radiation oncologists and their prostate cancer patients — from the day of diagnosis onward.

Here is a quote from early in the article that we find to be particularly key:

Given the nature of these conversations, sharing the facts with patients isn’t enough, … Doctors have to recognize patients’ emotional needs and respond to those needs if they want their message to sink in.

Once again, this gets at the “duty of care” that many see as being less well appreciated in healthcare and medical practice today than it was in the past.

Technology today allows physicians and other clinical personnel to “do things” (conduct tests, run scans, do surgery, give radiation therapy, you name it) with almost monotonous ease. That is what patients expect their doctors to be able to do for them — so that they can be cured. And that is what they (or the organizations they work for) get paid well to do here in America. By comparison, again, at least here in America, doctors are not well compensated for spending time talking with a patient and his (or her) family, and making sure that they really understand the situation.

Reese has put together a brief but helpful set of information about all the things that can get in the way of ensuring that a patient really understands what is happening, what needs to be done, why, and what his (or her) choices may be — along with the implications of those choices.

Getting physicians to really appreciate the complexity of what is going on on the patient’s side of the desk (or the exam room) while these conversations are happening may be a good deal more complicated. As Reese points out, now that doctors can “do” so many different things to a patient, there is a lot less education being given to physicians — in training and after their initial training — about how to communicate well and successfully with those patients.

Reese reports just one of the exempletive situations in which how a physician responds to a patient who may seem frustrated and angry is critical. The example came from Dr. James Tulsky of the Dana-Farber Cancer Institute in Boston:

Acknowledging a patient’s anger and even naming it can help defuse the situation, says Dr Tulsky. Simply saying, “You sound angry,” lets the patient know they’ve been heard and allows them to elaborate on their feelings. Anger is often a manifestation of fear.

The “New” Prostate Cancer InfoLink is increasing convinced that a major problem that affects medicine (and prostate cancer management in particular) today is the “disconnect” between what the medical profession does for a living and what the average patient needs more than anything else, which is a sense of being “cared for” and “cared about”. It’s no one’s “fault”. It has happened over decades, but we believe that it is critically important for the medical profession to recognize this disconnect and set out to repair it.

One Response

  1. Reminds me of the time, after PSA had risen to 1.22 from < 0.1 during the 9 months post-SRT, I had a meeting with a local medical oncologist to see what he thought I should do next. I had sent him my previous treatment info beforehand. He says, “We don’t usually see guys like you here. Most of our patients are in their 80s.” (I was 71). “If I give you the standard treatment you’ll be dead in 5 years. Tough to hear I know.” I said thanks and walked out.


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