What it's all about

If you've read this blog with any frequency, you know that I have an soft spot in my heart for cancer stories and patients who have been through the medical ringer with their diagnosis and treatment. My heart absolutely goes out to those abandoned souls who are left hanging without a physician who will advocate for them.

We had a patient presentation session this past week from breast cancer survivors treated by one of our faculty physicians. The stories of these women were sad and at the same time absolutely appalling. Between all of the mis-diagnoses, the poor attention paid to their needs, the lack of communication and the delays between procedures, it's a wonder that these women are alive at all. It reminded me why I wanted to get into this field in the first place and brought together a lot of what doctoring is all about.

-First patient: Hypodensity in one breast was missed over a fibroadenoma in the other breast. She was cleared for hormone replacement therapy. A year later, and she had full blown carcinoma that was being fed by her estrogen replacement...though that mechanism was not completely lucid at the time. Found the doc on campus and had everything taken care of and is still here to tell the story.

-Second patient: She made me extremely sad. She felt a lump, and had a mammogram done. She was diagnosed clinically with breast cancer on that mammogram. She requested a second opinion, and was sent to another oncologist at a prestigious ivory tower institution on the East Coast with another patient's films. The oncologist picked up on it right away, and repeat films were clean. Two years later, her films were not clean and so she returned to that same ivory tower practice to find that the physician had retired and left the practice in the hands of another doc. This guy was all about fitting in as many patients as possible. He drained the patient's cystic adenomas monthly for 8 months without biopsy, until one visit he stopped getting fluid. He looked at the patient and said "I think I made a mistake. Go see the receptionist, and we'll get you in for a biopsy." He didn't have an opening until 4 months later...so she left and came to our institution and found this doc who made everything all right, after a year of weekly chemo.

-Third patient: Basically got told by a doc at a NYC Cancer Mecca that she had breast cancer, and was not presented with the full amount of information that she requested. Great doctor, crappy care. The doctor gave her info and treatment options on a need to know basis and basically told her what she was going to do. She left out of frustration and found the doc at our institution who presented the entire picture of how they were going to get through it.

The take home message that I got out of this session was that communication is 95% of being good physician. If you're not able to communicate what is going on with the patient, how you're going to fix it and what they need to do, the patient is going to lose faith in you from the get go. Your work lies in finding and correcting the errors in physiology and anatomy of another human being!!! This is not some computer simulation or lab animal or entry in Robbins that you're dealing with, it's a person and their life and their family. You can be the most technically knowledgeable and capable individual in the field, but what takes you that extra step ahead of the rest is the simple ability to explain the situation to a very scared person, who may not be thinking rationally, and to make them understand what you're about to do.

I see so many of my colleagues lacking in this regard, and I worry for their future patients and the future of medicine.

1 comment:

The Lone Coyote said...

Communication is key. We've all been presenting real life ethical scenarios we have come across in our training this week, and the amount of poor communication that people have witnessed is astounding.