ubmslateCN-logo-ubm

CN Mobile Logo

Search form

Topics:

7 Things Oncologists Should Never Say to Their Patients

7 Things Oncologists Should Never Say to Their Patients

  • We can all agree that communication skills are essential to quality cancer care. Oncologists are expected to explain complex situations clearly, but what about the humanity of the communicators? Do their words reveal compassion and empathy, or do they unmask a callous person? Be on the lookout for doctors who say any of these—it could be a sign that they need an attitude adjustment.
  • “I’m afraid I’ve got bad news.”
  • Why not? Your patients wouldn’t be in your office in the first place if they hadn’t already received bad news. Acting as if you are starring in a daytime soap opera only serves to weaken the bond between the two of you. Please, please resist the siren’s call to be melodramatic when relaying information about relapse or progression.
  • “Is there some reason why you didn’t see your doctor when this started?”
  • Why not? In addition to asking a question to which you already know the answer (see “denial”), augmenting feelings of guilt in already embarrassed patients is simply an act of cruelty. We know it is exasperating to come across those who ignored their cancer until it is probably too late. Upsetting them needlessly is a classic passive-aggressive ploy that exists only to provide a morsel of schadenfreude to dyspeptic doctors.
  • “You’re just wasting your money taking supplements.”
  • Why not? Patients buy supplements because they believe they will help their treatment and also because it makes them feel good to take an active role in their care. Your job is to keep them from ingesting anything known to be harmful; otherwise, why not let them take supplements? We already know the benefits of ginger and American ginseng in the care of cancer patients. If nothing else, your patients might enjoy a boost from the placebo effect.
  • “I don’t want you leaving town.”
  • Why not? In case we forget, the whole point of treating cancer is so that patients can continue to enjoy their lives, including traveling to reunions, weddings, and graduations. In today’s world it is safer for patients on chemotherapy to go out of town. Do be ready to help out if problems arise, but don’t keep patients from their loved ones in faraway places. Have some confidence that things will go well.
  • “If you had not smoked this would not have happened to you.”
  • Why not? It is naive and condescending to think that smokers with cancer have no idea why they are sitting in your office. How does filling them with regret help with the healing process? It’s fine to discuss the science of tobacco-related tumors, especially if you have an opportunity to inspire other family members to quit—just eschew the holier-than-thou attitude.
  • “You have [insert number here] months to live.”
  • Why not? Everyone wants to know how long they have left, but none of us have the gift of precognition—especially oncologists, all of whom have stories of patients who mysteriously lived much longer than expected. Only fools and sadists pronounce patients dead while they are still alive.
  • “This treatment will not make you sick.”
  • Why not? Apparently (as my nurses are happy to remind me), I am guilty of saying this. Therefore, let me be the first to admit that even with modern supportive care, some patients do get aggravating side effects. Moreover, I do confess that, although it is as rare as a sighting of the Loch Ness Monster, some patients inexplicably lose their hair from a drug that “never” causes alopecia. Better to leave absolute guarantees to the omniscient and make your patients aware that there are exceptions to every rule.

Comments

Prescribing physical exercise is always good, if patient condition allows it.

Jose @

As part of my training when medical student, I was present in some liaison psychiatry consultations, of a Balint inspired group. The question they made to those referred to them was: Why do you think you were referred to this office?
I guess this is a good approach to the first visit to an oncologist, as it will give information about the mood of patient, and the grade of knowledge and desire to know about their disease, I'd suggest also not having relatives in the visits, they can be allowed entering later, to discuss things, if patient agrees. An ill person is not a child nor a dumb.
Publications good enough seem existing -ASCO-, to say that any supplement or herbal products or alternative medicines is noxious to PFS and OS, but I have not a deep analysis about if those with poor risk factors are more prone to buy these products, the number of posible drug-herb interactions and drug-food interactions is so huge, impossible knowing it all, that a good practice is telling the patient: 'The best you could do for your health is follow the physician and drug package insert instructions, and discuss openly here any doubt, without fear'.
Presentation is good, and practical.

Jose @

Nalakrats...you only have 10 more years of fishing left.

John @

Can't read these in Chrome.

Dan @

Currently, I am rather upset with Dr. who over saw my radiation treatments for tongue cancer and his nurse. I am now cancer free but received 30 rounds of radiation to my face and neck to help keep the cancer away even though my lymph nodes were not found to have any cancer cells. I have no doubt that my Dr. recommended what he believed was in my best interest. It may be that this was essential to keep the cancer from coming back. My gripe is that they did not tell me about the possible negative effects of the radiation. They white washed it and made it sound like no big deal. I was told most people need a feeding tube for awhile and it might effect my voice some but it was emphasized that these things would be temporary. Instead I have chronic, burning pain in my tongue and it is swollen so much I have to have all my food pureed because my tongue stays between my teeth and I can't chew food without biting my tongue. This is 5 months after treatments ended. I was not told that I could wind up with permanent pain, that eating problems could persist, that I would have trouble with my speech and that I may never sing again. I wish I could have known the about these negative effects before the treatments. At least I could have been better prepared. Now the Dr. keeps saying that he can't keep ordering the narcotic pain meds and prednisone that do help me and at the same time states that I should not need to apply for disability even though I can't talk or take a drink of water without severe pain. I do have a referral to a pain clinic but feel like my Dr. is abandoning me because I did not have the sort of recovery they wanted. I understand that the prednisone and narcotic pain meds are not good ones to stay on but I have a lot of pain and swelling that also need to be treated.

Terri @

Shame on that DR. and nurse! The treatment you went through is, as you now know, one of the most difficult to undergo. They were both too chicken to give you the facts up front and now they have basically written you off. You need to find a new Dr. Perhaps an ENT could help. I'm sorry you were treated so poorly by this "Dr."!

calla @

I have never been treated with such lack of compassion than by oncology. Self righteous, egotistical and downright hateful.

veronica @

As a former cancer patient all this is fine. But after the word "cancer" I heard nothing and I am a physician. It is very important to have a cool listening person when you get the news. My husband, a physician, heard things I didn't and told me as the occasion arose what the Doc said. At every visit he was there and at every visit I didn't remember some vital information. Especially about survival.

Patricia @

I am an RN and I had the same trouble. It was hard to apply my knowledge to myself. I am not married but have several good friends. At times one of them would take me to appointments and I would usually ask them to come into the room with me. I found it very helpful when they could remind me of things the Dr said. They also sometimes came up with questions I had not thought of but which really helped me understand things better

Terri @

I was diagnosed with ovarian cancer in 2012 after being a peds oncology nurse for 12 years. I had one of my colleagues go with me to the diagnosis discussion and then to the second opinion discussion. They took notes for my husband and I so I could look over at home at my own pace. This was such a good decision to ask them to be involved in such a manner. Being the patient a cancer diagnosis is overwhelming and your years of knowledge and experience can fly out the window when it's you sitting in the patient chair. And it can make your anxiety level go through the roof because you also know all the possible complications that can happen, or the failures of treatment... Healthcare providers get cancer too. If you have a patient that is in the medical field, do them a favor and suggest they bring someone along to help listen and ask questions. It's what friends do for each other.

Christine @

I did the same thing when I was diagnosed with Multiple Myeloma. My sister came along and wrote down everything the Dr said so that I could go over when I was at home without the stress of being at the Dr office. Very good advice. I am also an RN and yes, all your knowlege goes out the window when you are the patient.

Laura @

I was diagnosed with ovarian cancer in 2012 after being a peds oncology nurse for 12 years. I had one of my colleagues go with me to the diagnosis discussion and then to the second opinion discussion. They took notes for my husband and I so I could look over at home at my own pace. This was such a good decision to ask them to be involved in such a manner. Being the patient a cancer diagnosis is overwhelming and your years of knowledge and experience can fly out the window when it's you sitting in the patient chair. And it can make your anxiety level go through the roof because you also know all the possible complications that can happen, or the failures of treatment... Healthcare providers get cancer too. If you have a patient that is in the medical field, do them a favor and suggest they bring someone along to help listen and ask questions. It's what friends do for each other.

Christine @

As a former cancer patient all this is fine. But after the word "cancer" I heard nothing and I am a physician. It is very important to have a cool listening person when you get the news. My husband, a physician, heard things I didn't and told me as the occasion arose what the Doc said. At every visit he was there and at every visit I didn't remember some vital information. Especially about survival.

Patricia @

A very dear friend with aggressive breast cancer (metastasized to her liver and brain at discovery) was told she had four months to live - so aggressive was her cancer that physicians refused her a mastectomy. She switched physicians, began treatment and her mets 'disappeared' - she got her mastectomy and continued treatment for eight and one-half years...enough time to see her children graduate college, marry, and bear her first grandchild. She died, oddly, not 'from' the cancer but rather because a pre-existing cardiac condition prohibited her taking the most essential anticancer agents; she ultimately developed unresponsive cardiac failure. Thanks for your excellent points.

Doreen @

A very dear friend with aggressive breast cancer (metastasized to her liver and brain at discovery) was told she had four months to live - so aggressive was her cancer that physicians refused her a mastectomy. She switched physicians, began treatment and her mets 'disappeared' - she got her mastectomy and continued treatment for eight and one-half years...enough time to see her children graduate college, marry, and bear her first grandchild. She died, oddly, not 'from' the cancer but rather because a pre-existing cardiac condition prohibited her taking the most essential anticancer agents; she ultimately developed unresponsive cardiac failure. Thanks for your excellent points.

Doreen @

These are very useful suggestions we all must remember

GIANCARLO @

.

DANIEL @

physician should express his sympathy.

saeed @

خن

Mohammad @

خن

Mohammad @

thanks.Allah bless U

ashraf @

It is helpful to use positive statements too. "If things are not going well, I'll tell you, but we're not there yet." This tells them I haven't given up hope and neither should they. I rarely have to "tell them", if things get worse as we are on the journey together and reach that conclusion together.
Hope is so important and it doesn't matter that I'm hoping for a prolonged remission and they are hoping for cure. As long as there is hope life goes on. Worth re-reading the 1975 NEJM article on "Pascal's wager and hanging the crepe."

Catherine @

Some of the problem is young doctors who are very nervous about what to say and so they parrot the canned speeches they learn in the "how to break bad news" class in medical school. Some of the problem is pomposity and spectrum-levels of empathy. However, instead of being the source of all information, how about asking "What do you know so far about this problem?" Then answer their questions. Don't show off all your knowledge with every last "factoid." TMI too much information. Just answer their questions. If they don't know what to ask, offer the questions, answer in pieces, small bites. Chew well, swallow, sip of water, next question, small bites. Tolerate silence. People need to think. That's what they taught me. I think it "works." Tell the truth, e.g. "I can't tell the future. I can tell you the averages, but then no one is average." "I don't know." "Let's take it a step at a time and see what happens as we go."

Miriam @

As an Oncologist practicing in s vacation destination I have seen too many patients spending their vacations in the hospital with granulocytopenic fever. If you let your patient take a vacation while on palliative chemotherapy try backing off on their doses so they don't have to meet me.

Michael @

communication in oncology is like breaking an egg
one needs to be honest not use jargon but lay out facts in as simple terms as possible
neither be pompous nor be escapist in avoiding questions
one should definitely warn about supplements and tell the truth it benifits the seller more than the buyer if not it is a crime against our patient

narayanan @

One thing that I don't think many doctors don't realize is the impact of their words on a patient. As just one example.....When a patient hears those words..."YOU HAVE CANCER" his/her world stops on a dime. The brain is locked into that one statement. As a two time cancer survivor myself, BOD of the ECAA and a mentor in several capacities...I hear that comment echoed time and time again. Whatever is said AFTER that statement , in that office visit, is rarely heard by the patient. His thought is "I'm gonna die"! Breaking somebody out of that mental trance is difficult. This article reflects many of the comments that I hear from patients/caregivers. Without a doubt...the one question that a patient/caregiver asks the doc "How long does he have"...seals the deal in the patients/caregiver mind that "I'm gonna die" ! As a doctor...you could tell the patient/caregiver that they just won the multimillion dollar lottery and they would never hear it or it would never register in their minds.

STEVE @

After 25 years of practice (20 in hematooncology) guilty of all (except don't leave the town, perhaps).

"I am afraid I have bad news" - I'm not saying this when I see the patient first time, but surely I tell them whether they have less or more serious condition - among others, because they simple want to know! Beside tis, all of them come for results evaluation or surveillance visits. If the treatment is not going well or if there is a progression, I simply cannot make good news from bad news. If I'd try to do this, I would look as an idiot in the eyes of the patient and I am very doubtful if this would help the relationship between me an the patient.

"Is there some reason you did not visit your doctor when this started?" - well, not using exactly these words, as to my office (and I am sure that to most oncologists' offices) patients usually come after they already visited their family doctor and maybe some specialists as well. However, I ask them what these colleagues of mine did before the patient came to me, as it is quite important to know the natural history and reports from other doctors may be not accurate.

"You're just wasting your money taking supplements." My loyalty is to the patient, not to companies manufacturing these remedies. Patients may have enough financial problems because of their proper anticancer treatment. If the question about supplementary treatment emerges, I am trying to give the patient the best advice, and in some cases, naturally, we come to a conclusion that the cost/benefit ratio is very poor. Not to mention that some of the supplements may have interactions with chemotherapy (St. John's wort), or may contain toxic components (e.g., heavy metals).

"You have ... months to live." Patients, especially in their terminal stage of disease want to know about their life expectancy, as they need to wrap certain things up. Sometimes it is quite easy to give them an estimate on the basis of existing data. In other cases, they want to know at least if their live expectancy is weeks or months. I am very cautious with these predictions, and in cases when there are data, I explain the patient that these are not fixed, but median data and I explain to them what medians are. I always stress that some patients may live unexpectedly long, but I am also aware of studies showing that even the most experienced doctors tend to overestimate live expectancy of particular patient rather than underestimate it.

"If you had not smoked..." of course, most patients know that their lung cancer is because of smoking. But how many patients know that their bladder cancer may be also connected to smoking and that to quit smoking is beneficial in these cases as well?

"This treatment will not make you sick." Most patients are quite anxious because of the expected side effects of chemotherapy and experienced doctors know which regiments are more and which are less toxic. To reassure the patient that certain treatment regimen (i.e., most front-line regimens for lymphomas) is usually well tolerated is nothing bad in my eyes. Not to mention patients in clinical studies, where the printed information for the patients may contain dozens of possible side effects, most of which are rare or can occur even outside of the study.

During my studies and practice I have read a number of these "quick lists" what to do and what not to do - some were quite nice and helpful, this list, in my opinion, is dogmatic and confusing.

Robert @

excellent and valuable advice. I think there is a way around the supplement thing though. many patients have limited funds with regards to therapy and half the time prefer to channel their funds for supplements. good to appropriately educate them about it.

shaheenah @

Nice advices.

Chi @

As a healthcare attorney I was once called upon to deal with the after-effects of a physician (not an oncologist) who chose his words with no thought when talking to his patient about a new diagnosis of bladder cancer. The patient asked this doctor - "what would you do if you were me?" The doctor, never known for tact, replied - "If it were me I'd get in my car and blow my brains out." The patient filed a complaint with the licensing board and the doctor was reprimanded. I sent him to empathy school!! True story. The moral.... think!!!!!

Miriam @

Nice advices. But it would be good to give the alternatives.

"The supplements will not be of any help at this moment and you may like to discontinue now"

In India, some patients waste lot money and if you do not advice them appropriately, it is taken as your approval and you will be misquoted.

"Was there any particular reason why you went on with this big lump" would be answered like my daughters marriage or i didn't want to suffer the chemotherapy or some such answer.

"your chewing tobacco has been responsible for this cancer" will make him understand the situation, leave the habit and probably tell others about the habit. I feel in India it is appropriate.

Ranga Rao @

very nice

pinar @

very nice

pinar @

I have to say there is some essential communication skills missing here. Has anyone considered, asking the patient after the discussion. What is most important to YOU right now. It isn't about what the oncologist thinks , but after communicating treatment options and choices, shouldn't all be asking , what matters to the patient?

Lynne @

They absolutely do ! but. I do know that the chasm between the truth and empathy is v.v.v. Difficult. good luck Paul,

paul @

They absolutely do ! but. I do know that the chasm between the truth and empathy is v.v.v. Difficult. good luck Paul,

paul @

They absolutely do ! but. I do know that the chasm between the truth and empathy is v.v.v. Difficult. good luck Paul,

paul @

good comments for AlL MD's . This is good information for everyone from Peds to Geriatrics and especially new docs.

D.C. @

good comments for AlL MD's . This is good information for everyone from Peds to Geriatrics and especially new docs.

D.C. @

Uh, about the supplements... in most countries patients financial burden related to treatment is already big enough. I do not discourage them taking supplements, however, do all of you people think that we should not comment on cost-effectiveness of these frequently overpriced remedies?

Robert @

Broadly I agree. But one cannot generalise. If there is a patient with metastatic cancer, as an oncologist, I have to break bad news ! I cannot say " Don't worry, its only stage IV........!" It better they hear the "bad" news from me rather than a son or daughter where emotions may ruin the narration!
About supplements, I would not like them to be taken when a cancer patient is taking chemotherapy; so I will tell them to discontinue them unless I need it as a planned therapy!

Udaya @

I agree with you :)

Trang @

Cancercare requires Humanist and humble approach for Communicating with patients and relatives while even giving all possible Support for cure and palliation from all team members especially the Oncologist who steers the management. These words avoided also mean psychologic help for coping

Madhav @

yea it is correct.
But frequently the patient does not accept th diagnosis so if the doc is not clear he runs away abandoning effective treatments.

Paolo @

Thank you for this one. Simple reminders can be inspirational like nothing else.

Ivan @

Totally agree.

Sameh @

Agree. Patients know this already .One can ,and should say : " this cancer was caused by smoking " especially when family are around who may be smokers or know someone who smokes.

Sameh @

Agree.

Sameh @

I disagree moderately here.
This statement is ok if the wording is changed. One should say it without insulting a patient's intelligence. Again, these are not cheap. When a patient has to choose between a medicine that is prescribed and a supllement and he/ she has no money for gas, then this statement has a role in helping the patient prioritize. Because some may chose the supplement over a medication like Imatinib for CML!!! Do you think the ginsing is going to put the CML in remission!!!!!

Sameh @

again, this question may be appropriate in certain situations. I see this every day. Patients have no means or money to afford doctor visits . Noncompliance can have financial roots. Oncologists need to ask about this to avoid future no shows , and get patients the assistance they need. Some are too proud to admit to poverty. unless you plan on giving chemo at home????? Come on!

Sameh @

Pages

Add new comment

 
Loading comments...

By clicking Accept, you agree to become a member of the UBM Medica Community.