Communication is important in cancer care

Communication is the key to good Medical Care (CMC).
Current medical care is more complex as comparted to about 25 years back, as the advances in medical sciences allows for interventions far greater degree than it was earlier and the expectations of the persons with medical needs and their families is greater.
People want to know more, want to be part of the decision making process and expect the doctors to be as capable in COMMUNICATING information as in being technically competent to treat the medical conditions.
Here is an experience of person diagnosed with care, sharing the not good and GOOD communications.
Experiences of a person diagnosed with cancer(Anonymous)

A proper communication between the patient and the doctor can have a huge impact on the morale of the patient. Right from the diagnosis, beginning of the treatment to the completion of treatment and the follow up there-after, communication with the patient can either prove to be therapeutic and bring a sense of hope in her or it may just leave her sad, angry and dissatisfied.

As a survivor I can tell you that I have been on both sides and have experienced the good and the not so good way of communication between myself and the doctors.

A cancer diagnosis can leave any normal person completely shattered and sometimes traumatized. It takes immense courage and a totally different mindset to accept the fact and go ahead with the treatment process.

Talking to the doctor and understanding the disease and different treatment choices is the first step to a patient’s journey and I must say that the conversations with the doctor can make a HUGE difference here.

Let me first begin with the NOT so good conversations I have had as a patient because the diagnosis was the most stressful period for me.

I would also like to mention here that I am the kind of patient who likes to be informed about the chances and risks of the disease directly. I believe that no matter how bad the situation seems, I should be clearly told about it by my doctor.

I was diagnosed with high grade invasive ductile carcinoma, Triple negative and stage lllA.

I got the diagnosis and all the scans and lab tests done in a different hospital and I decided to get my treatment in a different Cancer Hospital.

Here are the reasons for this choice.

Not discussing the cost of tests:
• As soon as my reports came as malignant, I was asked to get several other tests by a medical oncologist. The doctor did mention the procedure of the test to me but he DID NOT tell me about the costs involved. I was assisted by a junior doctor to the various labs as I was alone. He would just perform the tests and show me the cash counter for the payments. Some of the tests were quite expensive and I had to come home and get the other tests done as I was absolutely not prepared for it.

I’m sorry to say this but I felt that the hospital was in the business of making money and the doctors just made sure that every department benefitted.

Not treating each patient equal:
• When I went to the doctors with all the lab reports, the first thing he asked me was where does my spouse work, his designation, whether I am employed or not, whether I have insurance cover or not.

I was again sent for more scans and tests.

The doctor then explained my disease and I was asked to start treatment immediately.

A patient is vulnerable at this time and I felt as if I’m the scapegoat here.

To be very honest, I felt that I am in one of the best hospitals in Bangalore which has best doctors but I was having second thoughts. I was just not convinced with the kind of explanations that were given to me by the doctors there and I didn’t have any TRUST in them. I was actually scared and indecisive about my treatment there. I had this clear feeling that the doctors just want the patient to spend as much money as she can without caring or having any considerations for the patient’s life.

Such communications forced me to take second opinion and go to other hospitals for treatment.

Thankfully I found an another centre for treatment.

I can’t tell you how different the conversations here were. I found hope here and the way my doctors explained everything to me also gave me the courage to fight this battle.

Good communication at the second hospital:

1)Before starting treatment, the doctors clearly mentioned the different stages of treatment.

2) I was told about the costs, the personal choices(whether planning to have another kid, was even told about sexual activity during treatment, confidentiality. Etc)

3)Doctor just mentioned that they have several insurance companies associated with the hospital, without asking me whether I have insurance or not.

4)I was not forced to get treated in this particular hospital. My doctor explained the scenario and left it on me as to whether to take treatment there or not, without getting into unnecessary details.

5) During treatment I was clearly instructed about the side effects and the do’s donot’s. My treating doctor was always patient enough to listen to all my problems, no matter how small and was always ready to clear my doubts. Psychologically that made a positive difference in the my health. My treatment procedure was not stressful at all as I knew that I was in safe hands. That assurance from the doctor actually made me believe that my treatment is effective and I can survive this.

6)I was never given any false hope by my doctor neither has he scared me with some worst case scenarios. Reassuring the patient that he/she will take one step at a time and I am there to take care of the complications/problems is all a patient wants. This relationship between a patient and doctor helps the patient goon with life and give her the strength to fight the disease.

7) After completion of the treatment, I sometimes felt lost as I thought that the doctor is not there to guide and tell me what to do. My treating doctor asked me to meet a COUNSELLOR to address my emotional issues and rebuild my life after cancer. Counselling benefitted me immensely. It helped me to find purpose and meaning in life post cancer and it also helped me to handle all the fears and uncertainties with ease.

8) Follow ups too did not involve getting unnecessary tests done.

I’m in remission for the last 4+(and counting) years and I am thankful to all the doctors for their part in my journey.

Related writing:
Should your doctor tell you if it might be cancer?
Wendy S Harpam, M.D. and Cancer survivor, August 28, 2018
Blog: Helping others through the synergy of science and caring

A physician’s heart may be in the right place while reassuring a patient, “Don’t worry. It’ll be nothing.” Unfortunately, trying to spare patients worry during evaluations can backfire.

Patients who are reassured and then find out they have a serious illness may suffer from…
• Increased shock (“I wasn’t prepared at all.”)
• Loss of trust (“My physicians didn’t tell me the truth about what those tests might show.”)
• Lack of confidence in statistics to help guide their care or to reassure them about a likely good outcome (“How can I believe I have a good chance of recovery? I was told not to worry about the test, yet here I am with this diagnosis.”)

In general, patients benefit when physicians mention the possibilities in hopeful ways. Better to hear it directly from the physician than from Dr. Google or a friend.

If your physician recommends a test, consider asking…
• What is the most likely result? What is the chance of that?
• What is the worst possible result? What is the chance of that?

While undergoing evaluation, Healthy Survivors remember…
• The results are uncertain, which means you could get the best possible news. (If your physicians knew the results ahead of time, they would not order the test.)
• You want news that helps you most, i.e., accurate news

Talk with your physicians about how much you want to know–or not know–to help you through evaluations. When the results are in, the truth will set you free, even if it hurts when you learn it

The Diagnosis Sets Us Free…Even If It Hurts When We Learn It

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