Finding the right words for my patients’ hard questions

On a recent visit to DC, I found myself feeling inspired; regardless of your politics, it’s almost impossible not to. At each monument, museum, memorial, and government building, I stood in awe of the boldness, faith, hope, and determination of our founding fathers and their unwavering belief in the future success of their American experiment. So many of these sites are inscribed with famous quotes from leaders who inspired generation upon generation with their words, quotes that laid the foundation of our country. The pen is indeed mightier than the sword.

Words matter. We use words every day with our patients along their cancer journey, and we can’t forget that our patients hang on to every word we use. These words can heal, provide comfort, and embolden hope; our words can also cause harm and be misinterpreted, leading to damaged relationships with our patients. As oncologists, we need to embrace our words and make efforts to better communicate with the people we care for.

Good communication isn’t learned overnight. It takes many years of watching and modeling mentors who are blessed with this subtle skill, as well as training and practice. Even the most seasoned attending will admit that this is a skill that they never stop honing.

By the time the patient is sitting in your waiting room, their life has already been altered by a word, just one word: cancer. They need a compass for the journey they are about to undertake, and we as the oncologists must be that compass and guide the patient regarding the next steps. And this can be hard for us, no matter how knowledgeable we are.  Unlike actors, we don’t have scripts that we can fall back on or a director who can prompt us with a line. When we are speaking with a patient, the words come from our heart, spirit, soul, and are shaped by our past experiences and an understanding of the individual in front of us. Sometimes we connect and build the bond needed to take care of the patient, and others time we fail. Just like we can’t accept the status quo of cancer treatment failures, I feel we can’t accept failing our patients with our words.

After eight years in practice, there are still questions that I struggle to answer. They, unfortunately, find a way into my clinic daily.

“Doc, so are we going to cure this cancer?”

When I was an internist, I wasn’t curing patients diagnosed with hyperlipidemia, diabetes, or coronary artery disease. I was controlling their diseases and trying to prevent future complications. But cancer is different. Telling my current patients that my hope is to control their cancer and turn it into a chronic long-term disease that can be managed with medications that cause low toxicity and minimal cost usually isn’t the answer they want to hear.

“Doc, if this was you, what treatment — if any treatment — would you choose?”

Even though I know this question is coming, the answer is always a moving target. Every patient has their own desires and wishes based on their faith, family, socioeconomic background, and their different attitudes and biases about life and death. Any answer I give to this question would be colored by my own biases, which doesn’t sit well with me. When I’m inevitably asked, I seek to find words that support them through the decision-making process and convey comfort and solace that they are making the right decision for them.

So where can we go to fine-tune our words to help our patients? I have been blessed to have many mentors from med school, residency, fellowship, and partners who have taught me how they connect with patients. The words matter, and so does the delivery. Turning the computer off, listening, following your patient’s cues, and reacting to their emotions demonstrate that you sincerely mean the words you’re saying.

Luckily, there are people smarter than me who have mastered this fine art of communicating with patients. I strongly recommend Oncotalk. It is really an amazing resource for oncologists in all types of practices to learn how to communicate more effectively to enrich the patient experience. I have worked at institutions, such as the Cleveland Clinic, where all physicians are encouraged to step outside their comfort zone and take dedicated classes where tools for effective communications are given in practical ways that we can take back to the clinic and improve our visits with our patients.

Although it is very hard to pick one, my favorite memorial in our nation’s capital is the Jefferson Memorial. It is secluded and isolated in the Tidal Basin, yet from that vantage you get a view of every important place in the capital: The White House, Washington Monument, U.S. Capitol, and Lincoln Memorial.

Thomas Jefferson knew that the infant country would grow over time and wrote that “laws … must go hand in hand with the progress of the human mind.” His words remind me how we as oncologists must continue to evolve to serve our patients well. Just as we keep with up the groundbreaking scientific advances that are occurring daily in diagnosis and treatments, let us also work to improve the words we speak and how we deliver them.

Take time in every clinic day to reflect on your patient interactions. Hopefully, you will be surprised to see how well you are doing, and maybe you will discover something that you have the ability to change and improve. Your patients will thank you for it in the long run.

Prateek Mendiratta is an oncologist.

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