Anxious About The Anxious Patient

Dr. H woke up in the morning feeling the dread. Thinking about how her day would look like was not a pleasant start of her day. On her schedule was a patient with stage IV cancer and the most recent body imaging revealed there was progression of disease.

Dr. H did not want to have that conversation with her patient. The discussion about the progression of disease and the plan of treatment. This was the third time that patient progressed through treatment. Dr. H had been taking care of her since the beginning.

The moment came when it was time to see that patient. The patient was accompanied by her son, whom Dr. H had never met before. As Dr. H accounted for the visit, she recalled herself discussing and explaining more than she normally would. She was going through the CT scan report line by line. She thought the son was asking a lot of questions, and they were questions more from doubt. She ended up spending about an hour for this patient visit, which was more than double the time she expected.

Many patients feel anxious, especially with oncology patients. They are anxious about the unknown. They do not know what to expect with treatment. They do not know if the treatment will work. In fact, patients are anxious because subconsciously, they think that they will have an unpleasant experience with the treatment. They think that the treatment probably will not work. They think that they cannot take care of other people or things like they used to.

When you are taking care of an anxious patient, it is best to do some preparatory work. You are already in an advantage when you are breaking the bad news to a patient you are familiar with. You know their personality. You know their habits.

Be sure to know what your plan is for the patient. What if there are more than one right answer? There will be more treatment options than you prefer sometimes. For an anxious patient, she most likely only wants to know what the gist of the scan report says and what the options are for her. She probably wants to know that she will be okay. If there are four comparable options, for example, it is fair to share with the patient that there are four choices, and you think that option 2 is the best because (you explain your reason). If you list out the same four options and ask the patient to choose, she will likely get flustered or even more anxious because she relies on the physician to make the best decision for her.

As a physician, the preparation work does not confine to reviewing the results and discussing the treatment options. It is more important to prepare yourself mentally. Emotions are contagious. When someone around you is anxious, it is easy for you to also feel anxious when you do not have a disciplined mind. As emotions are contagious, it goes both ways. When the physician feels calm and confident, it will influence the patient to feel less anxious and put more faith in the doctor.

Why was Dr. H carrying on a detailed discussion of the patient’s CT scan findings? Why was the patient’s son asking questions, to the point that Dr. H felt that she was being interrogated? Dr. H answered it herself as we were exploring together: she felt anxious. She felt anxious because she did not think she could calm her patient down. When she was focusing on that thought, the anxiety came up. As Dr. H was giving out that anxiety provoking energy, the son had doubts. He was questioning Dr. H’s capability to take good care of his mother – even though medically, Dr. H knew exactly what to do.

As you are preparing for a similar patient visit, allow yourself to feel calm because you are capable. You are expert in your specialty and acknowledge that for yourself. Be confident in yourself. Always go with a servant’s heart. You are here to help the patient in the best way possible, based on your expertise.

Let the patient know that you know what you are doing and you are there for them. This has much power in comforting the patient.

When you walk into the room, sit down and make eye contact with everyone in the room. Find out who they are if there are family members you are not familiar with. Find out why the patient is anxious. In other words, what is the main thought that is causing her to feel anxious? Acknowledge and validate the emotions. When someone is anxious about their cancer, the last thing they want to hear is to calm down. If you tell them to calm down, they may stop hearing what you are going to say. The patient connection is interrupted in such a way that you may have inadvertently built adversity between you.

When you validate the patient’s emotions, it is easier to offer a different perspective to view the situation, one that is less anxiety-provoking. All this time you are addressing the patient and the family in a calm and unhurried manner.

Keep things simple. Oftentimes the patient and the family members may not hear everything you say, especially when they are anxious. Use simple language and get to the point. You may just have to discuss that the scan showed more spots with cancer in the bones, rather than revealing exactly how many bone lesions there are, where they are located and what their sizes are – many radiologists do not even go into this degree of detail, especially for patients with metastatic disease.

Discuss the options of treatment. Depending on the patient, you may decide to have a brief overview of each option, or simply share that there are several options, and you think this particular choice is the best for the patient because of these factors.

Let the patient know that she is not alone. You are there for her. You are backing her up no matter what happens. You are there because this is what you do. You take great care of your patients and that is how you serve them.

Lastly, it is to motivate the patient to take action, that is, to make a decision. Decide to proceed or not. Decide on one of the possible treatment choices. You can only move forward if a decision is made.

No matter what specialty you are in, as physicians, you are going to encounter patients who feel anxious easily. It is important to know how that anxiety may affect you. You can choose calm and confidence to be your energy. You can choose to be present and let the patient know you are there for them. Although the anxiety may not completely disappear, all these will help the patient feel calmer and more at peace. You will spend less time with your discussion while having a more impactful and meaningful connection.