There’s so much to say about doctor/patient communication that even an overview of my thoughts is only possible in segments; therefore I’ll write several essays on this important subject. In my previous blog, I laid out general thoughts about what I feel actually defines communication. Specifically and most importantly, its basic ingredient is a two-way exchange – transmission and comprehension. Anything short of patient comprehension does not meet the gold standard. Put another way, without comprehension, the conversation is really only doctor’s monolog. Importantly, the ultimate responsibility for achieving this standard belongs to the doctor, rather than the patient – no matter what it takes. Bottom line, a physician should have the “people skills” and the concern to recognize when he/she is not making contact. Essential to communication is for the physician to be a good listener. Over time, I have become convinced that patients often have an instinctive sense of their own bodies, and on many occasions they feel something is wrong well before telltale symptoms or signs cause concern for their physician. While studying physical diagnosis in medical school, we were consistently admonished to listen to what your patient was saying; “they will often give you valuable information that you aren’t even seeking”, we were told. “Learn to read between the lines”. So when a patient says “something is wrong,” the wise doctor takes heed. Continue reading “More on Doctor – Patient Communication, from Dr. Roy Sessions”
Category: Guest Column
What is Real Doctor-Patient Communication?
There is an exhaustive general literature devoted to communicative skills, and in the corporate world – certainly in politics- and in most endeavors in which management of people is important, the achievement of this basic social asset is usually followed by reward. One frequently hears the colloquialism, “people skills” in reference to one’s ability to deal with human interactions. Truth be know, this is not a simple construct, and furthermore, it’s not a stretch to say that an ability to communicate is the key ingredient to people skills. It follows, therefore, that in the very important human endeavor of medical practice (especially cancer related medicine), clarity and comprehensibility of words are critical. Essential to the reader’s grasp of this entire discussion is the subtle but important duality of this statement. Let me explain what I mean.
Communicative and leadership matters have always interested me, and I have written and published on both*. In particular, I want to emphasize that the doctor’s communicative ability with patient and family – when the cancer is discovered – that required after treatment with the looming chance for cure – and that unpleasant communication when treatment failure becomes obvious – are all critically important. In the last of these circumstances, a death and dying discussion with patient and often family tests the compassion as well as the leadership skills of the physician.
Continue reading “What is Real Doctor-Patient Communication?”
Guest Columnist Dr. Roy Sessions: Spirituality and the Cancer Patient
Sometime during the 1990s, while I was practicing at Georgetown University Medical Center in Washington, D.C., I was asked to see a diplomat from one of the Middle Eastern countries. He was an educated and worldly man who had a throat cancer that required extensive surgery and post-operative radiation therapy. Just before the actual operation, I met with him and his wife in the bed-holding area, normally a hostel of heightened anxiety. As I approached the bedside, the couple greeted me with pleasantness and an extraordinarily relaxed demeanor – no doubts, no hesitation, only a mellow countenance in each. I remarked how calm they seemed. The man said “We are devout Muslims, doctor, and I have put my life and your skills in the hands of God. Once that was done, I stopped worrying because I know he will take care of me, and will guide you.” I remember this vividly because it was so definite and sincere. He really was fine with both the process and the inevitability of an outcome; essentially he had turned his fate over to Allah. I envied that intensity of faith under such important and scary circumstances. Continue reading “Guest Columnist Dr. Roy Sessions: Spirituality and the Cancer Patient”
Guest Columnist Dr. Roy Sessions: The Contemporary Cancer Team Approach
This is the sixth in a series of columns on the doctor/cancer patient relationship by Seabrook resident Dr. Roy Sessions, MD, and Fellow of the American Council of Surgeons.
Although less frequently then in previous years, cancers today are sometimes managed by the “occasional cancer doctor”. However, today’s diagnostic and therapeutic “standard of care” is the cancer team that is associated with a cancer center; and within the team, a multidisciplinary approach is ideally used in which the territorial interests of the doctors are subordinated to that of the patient.
Not too long ago, cancer management was less standardized (if at all), and not infrequently a primary care doctor who diagnosed a tumor referred the patient directly to a surgeon, to a radiation therapist, or to a medical oncologist. Where the patient started in the referral system had a lot to do with what treatment was ultimately employed. This is not to say that the treatment that followed was necessarily wrong, but the process did not lend itself to cross-fertilization of ideas between specialties; and additionally, the game plan–i.e. the treatment strategy–was inconsistent. In cancer management, nothing trumps a game plan in importance. Compare this concept to starting a business with or without a business plan.
With that said, Continue reading “Guest Columnist Dr. Roy Sessions: The Contemporary Cancer Team Approach”
Guest Columnist Dr. Roy Sessions – The Journey from the Referring Doctor to the Oncologist: An Anxious Time
Physicians and dentists generally send those patients with suspected or confirmed cancer to oncologists*. Referrers can be primary care doctors, gynecologists, endocrinologists, pulmonologists, gastroenterologists, otolaryngologists, dermatologists and others. Not uncommonly, at the time of the initial visit with a surgeon or one of the other oncologists, the patient is unclear as to whether they have a malignancy. Many of them have been told, but they did not hear what they didn’t want to hear. This reflects something I wrote in an earlier blog – the brain is an effective filtration system for frightening information.
In situations in which there is suspicion but no proof of cancer, the referring doctor may have told the patient, “You have a problem,” or “You have a tumor,” or “You have a growth,” but often the realistic possibility remains unclear or even has been denied in the patient’s mind; and let’s not forget (this should not come as a surprise) that many doctors seek to avoid delivering bad news. While that might seem like an abdication of one’s responsibility, it’s actually correct for them to skirt around the cancer or malignancy words until proof is actually established. In most patients, the use of slightly evasive terms such as “a problem, a tumor, a growth” is enough, unless for some reason, the next step of arranging for an oncologist is inordinately delayed, in which case it is more difficult to be vague. However, even if such is not the case, the patient will sometimes push the referring physician to speculate – this tricky conversation should be avoided! If the patient asks directly, “Could it be malignant?” the physician should be honest with a simple yes—after all, why else would the patient be referred to a cancer specialist? The physician’s mere concern raises the patient’s anxiety level, and it is generally wise for the referring doctors not to speculate on likelihood or other specifics. One is tempted to comfort such a patient, but on many occasions, the attempt introduces unrealistic expectations or conversely, greater anxiety. In certain circumstances, however, it is appropriate for the physician to offer general data that is favorable and that might give a patient cause for hope during this interim period. For example, approximately 80 percent of “incidentally” discovered breast masses in women turn out to be nonmalignant. This is a widely known fact, but a well – timed emphasis on it can be emotionally helpful to a frightened woman. Similar optimism is possible in a patient with a parotid (salivary) gland tumor, in which about 75 percent are benign. Quoting such generic data when sending the patient for a diagnostic procedure or to an oncologist is different from specifically making predictions about that particular patient’s mass. In the case of a potentially ominous tumor—a pancreas mass for instance— no real value is gained by quoting such generic data i.e. the dismal statistics associated with this particular tumor. In many cancers, the probability of cure is directly related to stage (degree of advancement), and in the process of quoting statistics, the bad as well as the good has been included in the calculus – that too should be considered in the attempt to help with generic data. All things considered, better the patient be properly worked up and staged before the prognosis is bantered about. Then, and only then, is it wise to discuss real data and specific outcomes i.e. prognosis.
Guest Columnist Dr. Roy Sessions: Quality of Life Concerns and The Search for Autonomy in Cancer Patients
This is the fourth in a series of columns on the doctor/cancer patient relationship by Seabrook resident Dr. Roy Sessions, MD, and Fellow of the American Council of Surgeons.
The days in which patients rarely challenged medical recommendations are long past, and an informed patient – even one with cancer – frequently seeks input into the decision process about therapy options. The paternalism of the past, in which a doctor’s advice was sacrosanct and unchallengeable, has appropriately been replaced with an inclusive approach in which the patient is offered choices – specific advice, of course – but choices nevertheless.
This new attitude comes out of the information age in which there is little proprietary knowledge, and importantly represents a search for autonomy in many informed patients. Truth be known, this new attitude is not only directed to the medical profession, but applies to the questioning of most authority figures – the law, the clergy, the modern family unit and others. For better or worse, blind acceptance of dogma is not the norm in 2014. Let’s explore this notion as it pertains to the management of cancer patients. Continue reading “Guest Columnist Dr. Roy Sessions: Quality of Life Concerns and The Search for Autonomy in Cancer Patients”
Guest Columnist Roy Sessions, MD: The Importance of Physician Beneficence
Discussions of beneficence have historically been sparse in the medical, and even the cancer-specific literature. However, because of shifting societal attitudes, especially as they apply to the practice of medicine, important basic changes have occurred that qualify this fact. Emphasis on patient education, their rights, their autonomy and the encouragement of self-advocacy have become the new norm, and despite a continued deficiency in the relevant literature, the very concept of beneficence has become essential to contemporary medical dialogue and thinking.
Continue reading “Guest Columnist Roy Sessions, MD: The Importance of Physician Beneficence”
Guest Columnist Roy Sessions, MD: The Relationship of Trust to Hope in Cancer Patients
In my June blog, “The Redefinition of Hope,” I promoted a more flexible characterization of hope among cancer patients by contending that goals less ambitious than actual cure ought to be part of the new vocabulary. Time for closure in life, restating affections, mending friendships, a tranquil death, and other desirables were cited as examples of this new vocabulary. I went on to state that trust between cancer patients and oncologists was essential to the development of hope, whatever its definition. Let’s explore the linkage.
Guest Columnist Catherine Farley: Breath = Balance for Better Health
Have you ever felt like you were on a see-saw and just couldn’t stop the “teeter-totter?” Or maybe a sense of entanglement where a direct path is difficult to envision. There are many times in our lives when we may experience these “sensations” or “feelings” that bring about worry or concern.
Whether the source seems to be rooted in work, family, health challenges, financial problems, or any other “teeter,” finding balance can come from within. Continue reading “Guest Columnist Catherine Farley: Breath = Balance for Better Health”
Guest Columnist Roy Sessions, MD: Redefining Hope
Dr. Roy Sessions will be authoring a series of articles for Tidelines. He is a Seabrook resident who specializes in cancer related health conditions. Please click to read his first article followed by his bio-sketch.
Continue reading “Guest Columnist Roy Sessions, MD: Redefining Hope”
Cancer Doctor is First Tidelines Columnist
Dr. Roy B. Sessions, a Cancer surgeon with superb credentials, is joining the Tidelines Blog with a monthly column. I interviewed Dr. Sessions one lovely Sunday afternoon, sitting outside on his flower covered deck in Seabrook. I had read two of his proposed columns for the blog and was impressed at his patient-focused treatment approach.
“Cancer care should be circumferential”, said Dr. Sessions, meaning everyone on the team should be giving support to the patient. “Cancer patients are intimidated by the illness; they are consistently frightened and scared, thus it’s the doctor’s responsibility to see that the patient understands what is going on. If the patient said he understood what I was saying, I would feel I had connected”, said Dr. Sessions.
In his retirement, he wrote a book about how the cancer treatment should unfold. The book is titled “The Cancer Experience, the Doctor, the Patient, the Journey”. In this book, Dr. Sessions lays out how important the role of understanding the cancer diagnosis and treatment is to the patient and the things the doctor can do to make the experience more understandable. The cancer experience should evolve with the help of a team of experts, all with one goal of getting the patient through the very difficult and frightening experience of cancer.
He talks about the toll cancer medicine can have on the doctors and other specialists caring for the patient. He feels this is part of the reason doctors can be arrogant; it is a self-protective mechanism that helps the doctor steel himself/herself from the pain of the patient. This may be true, but emotional involvement is critical to the process.
Years ago, doctors were unquestioned, and a deferential attitude was given to them which fostered an unrealistic attitude as to how the world was. Today with insurance companies setting up the rules, the doctor’s word is no longer accepted as gospel. The doctor is no longer the final arbiter of treatment. The modern attitudes have made the upcoming generation more inclusive. Dr. Sessions sees a young generation of people who is in tune to the emotional needs of the patient. Part of the message of his book is to help young people be good cancer caregivers.
We are delighted that Dr. Sessions has agreed to contribute to Tidelines. His first column will be posted on Sunday. It is entitled “Redefining Hope”.
Submitted by
Tidelines Editor Barbara Burgess