Are You Fostering An Effective Doctor-Patient Communication?

A friend pulled me aside the other day and asked for my opinion about her husband who has advanced stage 4 cancer. Let us call her Emily. Emily’s husband, who is in his 70s, was diagnosed with stage 4 cancer several months ago.  He received one cycle of systemic chemotherapy and was admitted with a serious infection. Since then, he has been back and forth between the hospital and rehab. He has lost a considerable amount of weight and has trouble standing up. He is currently in rehab.

Emily’s husband is under the care of another medical oncologist who belongs to a large group practice. While in rehab, Emily’s husband was visited by his main oncologist’s colleague. He informed Emily’s husband that there was nothing more they could do, and the recommendation was hospice. A second oncologist went to visit Emily’s husband the following week. This time, the oncologist said that they would focus the treatment on the quality of life.

That gave Emily’s husband some hope – hope that he would get some sort of treatment to control his stage 4 cancer. To Emily and her husband, the two separate oncologists seemed to have very different opinions. Emily’s husband is not agreeing to home hospice because to him, there is still a glimmer of hope to treat his cancer.

My heart sank when I heard this from Emily. Although I knew well that both oncologists meant the same thing – that is, aggressive systemic treatment for the cancer is not an option, and the focus is best to be on comfort and the relief of suffering. The way that was communicated to Emily and her husband made them believe that there was some other method of treating the cancer, despite the fact that he was mostly bedbound, weak and cachectic.

I had a long discussion with Emily and clarified what both oncologists meant. Without really giving her medical advice, I made it clear that I was pretending to be in his oncologist’s shoes, and what both oncologists were saying was that cancer treatment is no longer a viable option, and the recommendation is to shift the focus on symptom relief.

The doctor-patient relationship is a delicate one. When a patient is in advance illness, it is especially important to ensure the patient and the family are all understanding what you, the doctor, are saying. When you communicate with the patient and their family effectively, it will save you time and effort to re-explain the situation and to re-establish trust.

Making the connection between the physician and the patient or their family is an important first step. When you have a special bond with the patient or their family, it is easier for them to communicate with you and to trust you.

Keep it simple. Use simple words and sentences to convey your message and recommendations. It is also helpful to say the same thing more than once, in a different way, to ensure the listener truly understands what you are saying.

Read the non-verbal cues. It is important to notice anything from the patient of the family’s expressions or gestures to see if they are comprehending the situation. It is important to have eye contact.

Pause. If you are sharing a cancer diagnosis and the treatment, pause frequently to ensure all the parties understand everything up to that point. Sometimes, people are so immersed in the diagnosis itself that they keep nodding to what you are saying while their mind is only focused on the word cancer.

Pause also allows the opportunity for the patient and their family to ask questions. Make sure you are approachable and open to questions.

It is always important to keep in mind that you are here to serve the patients. You are here to help them in a difficult journey. It may not be cancer; it may be some abdominal surgery, some chronic illness or anything that is foreign and scary to the patients.

Do not rush – some conversations take a longer time to make the connection. Allow yourself that. Remind yourself that you have the time you need to help the patient and to ensure your discussion is received with the intended comprehension.

It is always helpful to summarize toward the end of the patient visit. This is a great way to once again ensure the patient and the family understand and remember what you discussed. It is also a good cue to let them know that visit is completed.

When you spend a few extra minutes to do the above, it will save you a lot in the long run. You are saving the patient and their family from having emotional damage caused by the false hopes. You are saving yourself time to explain or clarify what you were saying. You are saving the unique doctor-patient relationship and keep the trust factor.

Effective communication is a delicate skill that no one is perfect, and that is ok. It is always a learning process. The more you are aware of the kind of connection you have with you patient, the better you know how or what to communicate with them. Keep things simple. You do not have to spend a whole day to get the point across; you will spend the time you need to ensure the patients, their families and you are on the same page.