Friday, December 10, 2004

Communicating With Patients

Medical oncologists spend a tremendous amount of time communicating vital information to patients and their families. In order to begin a treatment designed to attack cancer, much must be done to educate them about the goals of treatment, the limitations, the risks and side effects, and the logistics of the treatment schedule. This information must also be given in such a way that not only are patients enlightened about their therapy, but that all involved are satisfied that the oncologist is indeed:

A. competent - not ill-prepared

B. confident - not vacillating

C. compassionate - not callous

D. considerate - not inflexible

Since I have a keen interest in improving the care of cancer patients let me, T.C.O., provide some simple advice on how a doctor might fulfilll the basic requirements of effective patient communication.

The Cheerful Oncologist's Tips:

1. If feasible, always sit down when counseling - it sends the message that you are not in a rush to get out of the room.

2. At the beginning of the visit, learn the identity of all who are in the patient's room - relatives, friends, ministers, etc. It is courteous, and you never know who might be in there with the patient. It could be someone important in providing care, such as the patient's power of attorney.

3. Don't speak too rapidly, or shovel out reams of facts about the patient's case. People under stress cannot process a lot of data. Take it slowly, with pauses at crucial points in the relaying of information - especially if it is bad news. We all need time to react and it is doubly hard when stricken with a serious illness.

4. Never, never use medical jargon without immediately translating it into common English. It amazes me that some doctors still assume the average lay person is bilingual!

5. Look the patient and family in the eye! You wouldn't want to give the impression that you're lying to them or that you have no faith in the treatment you are proposing.

6. Of course, leave time for questions. If you know of a vital question that hasn't been asked, ask it yourself and then answer it.

7. Give some encouragement, for cryin' out loud! We oncologists are in the profession of killing cancer, relieving suffering, and prolonging lives - if we believe that our treatments can meet these goals then why keep it a secret? Why not make an effort to lift everyone's spirits, so that we all start out with dreams of recuperation, if not healing, if not triumph?

8. At the end of the visit go around and shake everyone's hand. Again, it is polite and it sends the message that this patient's welfare is now your mission.

Successful communication with patients is not difficult when you, the doctor maintain two visions - first of patients and families leaving despair and fear behind as a result of your counseling, and second of you, the doctor sitting in the chair occupied by your patient. Yes, just sit for a minute in this chair and imagine yourself waiting...waiting for the door to open, waiting for the battle of your life, for your life, to start.

You sure would want a good communicator now, wouldn't you?

8 Comments:

At 2:41 PM, Blogger Lemon said...

i just came by via blog explosion...you give me hope in the medical profession! thanks for the good read.

 
At 3:11 PM, Blogger pecheur said...

Hey randomly found your site!! I love it.

Back in college used to be a lab assistant in a Cancer Research Lab. Thanks for a great work. See you again

 
At 3:25 AM, Blogger DisappearingJohn said...

I am a nursing student, and I really appreciate your blog. Your stories are moving, and well written. Having lost my mother to cancer early in life, I have dealt with many oncologists, and have untold respect for the profession.

That being said, in my clincals this week, I was in the room when a pediatric oncologist visited one of my patients. The parents asked many questions, and it was clear to me that the oncologist had not been as clear as he should have been when discussing initial options. After each question, the doctor would ask, "Can I see the information I provided you earlier?" One the parent reached back into her bag to retrieve the paper, he would carefully point out the answer to her question, saying, this is what I told you earlier, remember?

While I understand the importance of providing written reinforcement of what is being said, (since people in crisi rarely have the retention skills they need) this doctor seemed to almost be saying, "Pay attention when I talk to you, and read the stuff I gave you, so you won't waste my time..."

I was really offended; although the parent was still too far in shock to register any emotions other than fear..

John

 
At 11:50 AM, Blogger Dr. Craig Hildreth said...

To Azbigjohn:

You're right - you must have tremendous patience in order to counsel about cancer treatments, because whether you like it or not, you will be forced to repeat what you said - sometimes again and again. My advice to the oncologist: "Get used to it."

 
At 4:00 PM, Blogger Graeme said...

AZBigJohn has provided a great example to focus some of my thoughts on the question of doctors communicating with patients. I guess I should say that I'm not a medical professional, and I'm not a patient, so my thoughts are hypothetical.

If one of my children had cancer, I'd definitely want things written down, starting with a one-page summary. Given that my ability to process much of anything would be impaired, one page might easily be my limit. I'd want that front page structured very clearly: perhaps diagnosis, treatment options, recommended treatment, treatment schedule and possible/probable outcomes. By clear, I mean that the typography and layout should be clear, as well as the wording.

I'd put a slightly different spin on medical terminology than our cheerful host: I'd want specific terminology -- the same terminology that one oncologist would use to describe the case to another -- so I could look up information on the Internet. Naturally, an explanation in layman's terms is also useful.

If one of my children had cancer, I can easily believe I'd ask a question that had already been answered. I don't think it's unreasonable for the doctor to point that out. (Although his manner might have been less than perfect, as AZBigJohn implies.) In a situation where ability to communicate is compromised, it can be important to distinguish between old and new information. And if I was stuck in a loop, I'd want someone to whack me hard enough to get me unstuck.

Perhaps one mistake the oncologist made was not to provide any structure for conversation with the parents. If I had that one-page summary in my hand, I'd appreciate having the doctor go through it section by section, step by step, even if nothing had changed. If someone is holding a sheet that says the next treatment is Tuesday of next week, and they ask when the next treatment is, what they're asking is, "Has anything changed?"

 
At 12:58 PM, Blogger jon said...

I was looking at your posts about asbestos cancer and found a good article about the same asbestos cancer info too...

God luck with it : )

 
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