Communication

Over the thirteen years of my practice I have been “fired” by patients.  It is a great point of pride that these occurrences have been far and few between, but when they have occurred they are situations that are difficult for me to forget.  The common theme of these instances when patients have left my practice for another physician has been generally a lack of communication.  One instance that occurred, very early in my career, involved a young patient with chronic lymphocytic leukemia, she presented with a very elevated white blood cell count and the diagnosis was quickly made.  I followed her for many months, each time our visits were spent talking about how chronic lymphocytic leukemia was sometimes a disorder that required no treatment. I spent a great deal of time explaining why even though she had cancer and even though she was young, my recommendation at this point was not to treat her.  Over the many months that I followed her, her disease slowly progressed and eventually reached the point where I felt treatment was necessary. I recommended treatment to her and was surprised at her reaction.  She immediately sought a second opinion and left my practice.  In analyzing this situation I learned a valuable lesson, I had spent months talking with her trying to build a relationship but when the time came to make the decision for or against treatment, I failed to spend the time communicating to her the reasons why at some point she would need treatment.  The fact that I was recommending treatment when I did came to her as a shock and I, in fact, did a poor job at preparing her and explaining the reasons why she needed treatment. 

Many years later, I was at a survivorship conference and was surprised when the same patient came to speak about communicating with physicians. I sat there listening to her story on how her first oncologist (me) seemed to treat her only as a number and how her present oncologist had spent the time to get to know her, and understand her feelings.  I was very gratified that she was doing well. I also was embarrassed that her words again reinforced how poor a job I did with her. As a physician we must work to develop a relationship with our patients and that despite time restraints and a busy schedule; we must be able to spend the time to listen to our patients and develop their trust.

A recent article from the journal published by the American Association for Cancer Research by Kevin Begoss, talks about relationship building and what it takes to create a strong patient-doctor partnership.  I think it’s a wonderful article and in that article it gives some fine points of developing a good doctor patient relationship.  It states, “Every doctor-patient relationship is unique so there are no absolute rules for how to establish good communication.” Nevertheless, based on patient and doctor feedback for this article, several important themes were identified;

 For patients: 

1) Think and talk about communication needs from the very beginning of your relationship with the doctor.

2) Find extra support in the early stages after diagnosis, have someone accompany you to your appointments or develop a support network in addition to your doctor.

3) Educate yourself and take notes to your doctor’s visits, write more notes during that appointment.

 4) Get a second or third opinion if you wish and develop a trusting relationship with the doctor that you choose.

5)  If you’re not comfortable with your doctor, consider switching to a new one. 

For doctors

1) Remember that your patient’s need emotional as well as medical support.

2) Learn some details of the patient’s personal life.

 3) Accept the possibility of both good and bad information coming from the internet.

4) Patients who don’t ask questions may need some coaxing.

5) Beware of racial and economic disparities that may affect communication.

I believe these are very good points for both patients and doctors to use to develop what is needed in their relationship.