Not only is this news difficult to receive, but it’s difficult to deliver. There they are: two people in an office, one with news to give and one with news to receive, two people occupying the same space and time, within the same moment, both under duress (it is stressful to deliver such news, just as it is stressful to receive such news, however the former is much more short-lived) and both will meet in the middle, somehow, to manage the news that will be shared between the two people.
Regardless of what side of the desk you are on, a doctor is still just a person, in the same way that a patient is; so, how do you say, “You have cancer,” to someone? There is no written, correct way to do so, but however it’s presented, it will lay the groundwork for many things to come, notably one’s perspective.
Perspective is defined as a particular attitude toward or way of regarding something, a point of view. And that’s just it: how one is given the cancer diagnosis may correlate with one’s cancer treatment experience. This article will briefly examine, from a physician’s point of view, certain non-biological/social aspects of cancer care and why the doctor-patient relationship is so important and fragile.
“I was frightened and devastated. It was hard to concentrate on what the doctors were saying. I found it helpful to write things down and to have someone else with me to hear the information.” This is an excerpt from the Breast Cancer Update Patient Perspectives Project from 2003. It is critical that the physician choose carefully how he or she presents such a significant diagnosis to a patient. From that point on, the recipient will forever live with it. And although one’s perspective may change over time, the initial delivery is critical in helping to form a patient’s perspective. Delivered harshly and the perspective may be that of despair or hopelessness; delivered in a mutually beneficial way and the patient may foster a perspective of hope and healing. Further, what discussions ensue after the initial impact are important as this is a time when a patient may need to make critical decisions. Thus, how a physician regards the patient at diagnosis may determine the course of the doctor-patient relationship into the future.
That is, of the physician, by the patient. So often I discuss with my patients that they are the boss, and that they have hired me, an expert, to do a job for them. This type of perspective is empowering for patients and also critical for them to realize that they have hired me. It is important for both the patient and the physician to hold similar attitudes about this in order to deliver a consistent message during office visits. When the doctor-patient relationship is regarded in this way, it can be incredibly powerful.
Just as a patient can hire a physician, a patient can, and sometimes will, fire a physician. But the same is true the other way around. A doctor can fire a patient. Usually a patient will fire a physician when the patient feels he or she is not being cared for in the manner in which the individual would wish, that he or she is simply a number and not being treated as an individual or if the patient’s philosophies are not aligned with that of the physician. A doctor may fire a patient if such patient is not compliant with treatment or diagnostic plans or if the patient is putting him or herself or other patients’ health at risk, for instance.
Once the relationship is established and agreed upon, the process can then begin. The care of the person with cancer often requires a village of people. At the start, there may be many physicians involved with the diagnostics and workup. Then once the diagnosis is made and treatment has commenced, other village members play important roles – such as the clinic support staff, family members, friends, physicians and ancillary providers. Oncology treatment often is debilitating, depending on the condition of the patient, the bulk of the disease as well as the type of treatment being delivered. Patients become fatigued, worn out, sick, weak and hence the need for other village members to help maintain the treatment plan. Henceforth, once treatment has been completed, there is a recuperation process that then needs to take place and that calls for yet another group of village members. It is important for the physician to hold the perspective that he or she is a member of a team and although that doctor may be the captain of the team (for this analogy, the patient is the team owner) he or she is a member nonetheless and as such, all parts play a role.
The Heavy Lifting
Heavy lifting is a lot about perspective. Much of what I consider heavy lifting is when it comes to patient outcomes, what happens after treatment. For instance, will there need to be lifestyle changes? Dietary changes? A divorce? A new job? These are all big questions and not all questions are relevant to each person. But perspective is important and often the appropriate perspective can help a patient achieve greater and more robust levels of success than otherwise thought. FBN