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Giving difficult news to patients requires doctor to be clear, yet sensitive

Editor's note: Recently, Personal Best reader Don Derkach e-mailed us with an interesting question: Why do doctors utter the word "cancer'' before they are absolutely certain of the diagnosis? He told us of the anxiety he suffered waiting for test results that turned out to be negative for cancer. "What is it with the medical profession? Cancer, leukemia, malignant and other life-threatening words should not be uttered until there is certainty,'' he wrote.

We posed Don's question to Dr. Jerrold Sharkey, a Tampa Bay urologist with a special interest in prostate cancer who recently wrote a series on the subject for Personal Best (you can find it at www.tampabay.com/health).

Here's his reply.

One of the toughest jobs a doctor faces is telling a patient he or she may have a serious illness. I don't believe it's more compassionate to say nothing until a diagnosis is certain. But the way possible diagnoses are discussed is the key.

Patients need to have intelligent reasons why they are going for certain tests, and also what the doctor suspects. Some tests are more invasive and expensive than others; I know I wouldn't want to undergo medical tests if I didn't understand the reason.

In my years of practice, I've found most people want to know what's going on in their bodies. For some patients, it may take longer to process difficult news.

Being vague can be far more frightening than the truth, told gently. If, as a doctor, you say, "Something isn't quite right, let's set you up for blood work and an MRI,'' some patients will go directly to their computers and come up with a list of far more horrific possibilities than you had imagined.

Others might skip the tests entirely, figuring no news is good news.

Either way, the patient is not getting proper care, from my point of view.

The doctor should list the possible diseases the exams might expose, including cancer, without scaring the patient needlessly. It's important to stress to the patient that as a doctor, I do not have a crystal ball and that not every test shows a serious disease.

I do agree that before a doctor has the results of any tests, it's unwise to talk about treatment options and survival rates. That kind of information is overwhelming and would tend to make the patient think the doctor has already made a diagnosis. Doctors should just stick to what they really know at the time, and do it with caring.

Doctors cannot predict their patients' emotional responses, but they can be gentle and empathetic in their approach. They should allow time for patients to ask questions, and assure them they can call back as more questions arise.

It's just as important for the doctor's staff, from other medical personnel to the receptionist, to treat patients in the same empathetic manner. It's the doctor's duty to make sure they get the training to do so.

As a young doctor, I tried to shoulder the emotional burden for my patients, but of course that's impossible. All I managed to accomplish was tremendous personal stress that, over years of practice, would only have led to burnout.

Would more training help doctors communicate better with their patients? That's hard to say, but I do think the topic is getting more attention both in medical schools and national medical meetings.

In my early years, I made house calls, covering for primary care doctors who needed time off. That experience — going into patients' homes and meeting their families — taught me a lot about compassionate communication. I don't know if that experience can be duplicated in a medical school class.

I've seen new doctors as well as those in practice for years lack the ability to speak plainly yet compassionately to patients. Overall, most doctors do pretty well, and some are exceptional.

After 42 years in practice, I'm still learning about doctor-patient communications — both from how I react to what my own physician tells me, and from how my patients respond to me.

Giving difficult news to patients requires doctor to be clear, yet sensitive 08/27/10 [Last modified: Thursday, August 26, 2010 2:53pm]
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