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