Clarify Rather Than Assume

At the end of the day, I was scheduled to see a new oncology patient. Let us call her Tammy. Tammy is in her 60s and was admitted to the hospital about a month ago for severe abdominal pain and unintentional weight loss of fifty pounds in four months. She was found to have a large mass in her colon. During her hospitalization, she received blood transfusion for anemia and underwent a hemicolectomy. Pathology revealed a stage II colon cancer.

When I walked into the exam room, I greeted her and her companion with a smile. After introducing myself, I asked who her companion was – her domestic partner. Although I thought that gentleman was likely her significant other, I asked to make sure my assumption was correct. Earlier in my career, there were rare occasions when I was wrong – thinking it was a husband and wife in the room when they were siblings, for example.

It is very important to make sure the patient understands why they are in your office. Meet where they are. I always ask the patients to use their own words to tell me the reason they are here. I also ask them what their understanding of their diagnoses is.

When Tammy told me that there was a tumor in her abdomen, I thought we were on the same page. I started talking about how the surgery was a success to have achieved clear margins and she was sent to my office by the surgeon to discuss adjuvant therapy.  We started to discuss how the colon cancer had high risk features and that was why chemotherapy was recommended, to minimize the risk of recurrent or metastatic disease.

After a while of discussing her diagnosis, treatment and potential adverse effects related to the chemotherapy, I paused and asked if they had any questions. Tammy asked if she still had a tumor in her abdomen. I was taken back. All this time I assumed that she knew that there was a tumor in her colon and that it was removed in surgery. Somehow, she knew there was a tumor in the colon and she underwent surgery. Yet she did not realize the surgery removed the mass.

I was glad to have detected the misunderstanding. Doing my best to explain in the simplest way possible, I discussed with Tammy that the surgery was to remove the colon mass. Surgery was successful as it removed the entire tumor with surgical margins free of tumor. We were there to discuss chemotherapy because there could be microscopic cells which escaped and left behind. As there were some high-risk features, there is an increased chance of recurrent cancer.

Tammy finally repeated after me that her cancer was removed and there was no cancer in her body. She finally expressed understanding of her own condition and the reason to receive chemotherapy.

If we are not on the same page as the patient, any discussion may lead to misunderstanding. Do not assume patients know something or not know something. It is important to ask them and allow them to express their understanding in their own words. That way, you will find out what the patient’s conception of their condition is.

Always pause to allow for questions. A new diagnosis may take time to take it all in. Even though, to you, you may have explained things in a simple and easy to understand manner, the patient may still have questions or misunderstandings of their condition. As much as you want to stay on time, be patient. Check to make sure the patient has a full understanding of their diagnosis and treatment. This will minimize miscommunications and frustrations in the future.