Caring For The Anxious Patient

Miss T was in her 70s. She was referred to see me for stage IV breast cancer. As I was reviewing her chart, a plan was forming in my head.

The medical assistant guided Miss T into the exam room. After the basic intake was done, it was my turn to meet her. I opened the door – there she was, looking at me with her eyes wide open. I could sense her anxiety and fear at the other side of the room.

I walked into the room with a smile. “Good afternoon, Miss T. I’m Dr. Leung, nice to meet you.”

She said “hi”. I could feel her trembling body.

“How are you doing today?” This is usually how I start the conversation with my patients. How they answer it tells me a lot.

Miss T replied, “Not good. I have cancer that has spread to my bones. Am I going to die?”

Miss T is anxious because she has metastatic breast cancer, which she does not have anything to do with. That itself is enough to cause many people to be scared. She is also anxious because of the fear of dying from the cancer.

As an oncologist, I encounter patients who feel anxious on a regular basis. Many are newly diagnosed with cancer. The fear of the unknown may be nerve wracking. You do not know what to expect. You do not know how you will feel. You do not know if the treatment will work or if you will have many adverse effects from the treatment.

Taking care of patients is more than just addressing their oncologic diagnoses. To help them navigate through this journey, it is important to acknowledge their feelings and concerns. Doctors offer solutions, the treatment plan to tackle the cancer in this situation. It is very important to also acknowledge and address the psychosocial aspects of the patients.

Start with the front desk. Create an environment that is warm and calming. The team work starts here. Friendly and calming staff sets the tone of the office.

Pay attention to all the cues the patient is offering. The spoken words, the unspoken gestures, the aura in the room. Be curious and ask the patient if she is anxious and why.

Keep things simple. It is more important to connect with the patient at a personal level than to spit out and overwhelm the patient with a lot of medical information. Oftentimes the patient is not truly hearing or processing what you are saying, because all they are thinking about is the diagnosis itself or what they are anxious about.

It is important to acknowledge the patient’s feelings. A good relationship starts with being on the same page. That is, the patient feels that they are being seen and heard. Acknowledging the feelings does not mean you have to feel the same feelings. It is more effective to communicate with an anxious patient with calmness and with kindness. Let them know that you are the expert and will take great care of them. Let them know that although there are many unpredictable things in life, and there is no 100% guarantee in life, you are doing the best you can to help the patient. Let the patient know that there is a whole team of people behind their back.

As you are sharing information and making recommendations, repeat your message. Pause. Allow the opportunity for the patient to ask questions.

Offer the patient that, although she is an “anxious person”, it is possible to be open to view things in another perspective. The unknown is scary and it is okay to make the first step to give (the treatment) a try.

This was what I did with Miss T. As the encounter went on, she stopped trembling. Her breathing slowed down. She was in a more neutral space and less anxious. Before she left, she thanked me for taking the time to explain everything. She did not mention about the fear of death. She was ready to give the treatment a try. Even though the outcome was out of our control, there was hope.

Hope is a powerful thing. With hope, there is a reason to do certain things. There is a reason to live. As physicians, we are here to take care of patients’ diseases. For me, to take care of patients with hematologic or oncologic problems. In addition, it is more important to take care of the person at a human level.