Interview with an Oncologist on Doctor-Patient Interactions

source: http://philologica.net/studia/20110121233000.htm

ana !endelov" 2011-01-21 The article is an interview with a Czech oncologist presenting her views on the importance of doctor-patient communication for the successful treatment of the patient. The interviewee responds to questions prepared by . !. "evin some twenty years ago.

Introduction
#s one part of the epilogue to a collection of studies labelled Doctor-Patient Interaction $ed. von %affler-&ngel 1'(')* . !. "evin interviewed +. ,. "evin* a renowned gynaecologist oncologist* on doctor-patient interactions. #ppro-imately twenty years later . was as/ed $being an oncologist as well) if . could respond to the identical set of questions. The aim of the request was twofold0 $1) to find out a Czech perspective on e-actly the same topic and* more importantly* $2) to see what changes in 1udging the importance of doctor-patient communication might have ta/en place within the two decades.

Interview
Do #ou $eel that having a good rapport with the patient might %e help$ul during and a$ter the operation& . do* absolutely. 2oreover* . have personal e-perience which confirms this. #ppropriate communication $although it is* in my view* almost impossible to provide a strict definition of this) enables us to calm the patient down as well as to establish a partnership and collaboration with the patient* which is the starting point of any successful treatment. #s regards the operation itself* it is important to ma/e sure that the patient /nows about all the ris/s and potential complications of the medical intervention* but* at the same time* it is necessary to assure her that we $doctors* nurses) do as much as we can to handle such undesirable events. 'ow do #ou actuall# accomplish this& 'ow do #ou tr# to instill this will in the patient(s active participation& 'ow do #ou actuall# convert the patient& 3irst of all* it is essential to inform the patient about what types of treatment and4or therapy are available and why. .f it is possible* it might be useful to let the patient choose herself what cure she prefers and what* by contrast* she re1ects. .n other words* it is essential to /eep as/ing about the patient5s own ideas regarding her diagnosis* treatment and future prospects. . need to /now what the patient wants* whether she

e-pects complete recovery* slowing down the progress of her illness* or 1ust pain relief. .f our opinions differ* . always try to draw the patient5s attention to relevant details to show her what is* from the perspective of her diagnosis* feasible. Do #ou do most o$ the tal)ing& *hat is the role o$ listening& .t depends on the /ind of patient. There are patients who wish to tal/ about their troubles with health* and there are also patients who are silent. #s regards the former group* . always try to listen to them attentively* and give them enough time so they are able to e-press all they would li/e. 6ith the latter group . attempt to be as clear as possible. 7f course* listening on the part of the doctor is important* but often there are situations when the patients prefer doctors to be informants rather than listeners. #s far as my e-perience goes* most patients start tal/ing during our second meeting. In a situation where #ou want to tal) to #our patient %ut #ou do not have that much time to esta%lish this relationship+ how do #ou proceed& .f there is not enough time for a longer interview* . simply tell the patient that we really have to see each other again. 7ncology is a branch of medicine where doctor-patient communication plays a crucial role and it cannot be avoided or omitted. "o far all the patients have been willing to ma/e another appointment. Do #ou have an# methods o$ sending out nonver%al messages& *hat a%out touching& Ph#sical contact& 8onverbal messages form an inseparable part of doctorpatient interaction. 2imics* gestures* haptics* eye contact* body spacing and posture 9 all that should be ta/en into consideration. . ma/e use of all these types* some of them intentionally* other types subconsciously. . employ touching when the patient is disturbed. #lso during my daily ward rounds . hold patients5 hands when tal/ing to them. uring medical e-amination . often use one hand for e-amining the patient* the second hand to touch the shoulder or the hand of the patient in order to soothe the patient. :ogically enough* it is not viable each time because frequently the medical chec/-up requires both hands. ,ou re$er to relatives and pro%a%l# reali-e how ver# important the in$luence o$ relatives on #our patients must %e. 'ow do #ou tr# to assure that #our communication will later help them to tal) to #our patient+ which might also help her to %uild up a positive attitude and assurance that things will get %etter& 3irst of all* it is inevitable to respect the patient5s will* i.e. whether she allows us to inform her relatives or not. "ometimes patients do not want their relatives to be informed* and in such cases it is quite difficult to cooperate with them. 6hat we usually do is that we gently refuse to share any information with them* and we refer them to the patient herself. .f we do get permission to inform the relatives* then . ma/e an effort to give them e-actly the same e-planation as . have given to the patient. "ometimes the relatives want to /now how they may contribute to the treatment* and . always stress the importance of their support* the relevance of the contact with partners* family members* friends* colleagues from wor/* etc. 6hat may* on the other hand* also

happen is that the relatives refuse to participate in the progress of the treatment. 8onetheless* this might be solved 1ust by telling the relatives that the disease or the illness the patient suffers from is not dangerous for them and that they do not have to be afraid of getting infected. ,sually they rediscover their lost resolve. One o$ the main o%.ectives in communicating with the patient is to esta%lish some sort o$ human relationship. *hat is the main purpose o$ this& Is it primaril# to reassure #our patient that things will go well& &stablishing a relationship with the patient is very important in order to develop trust between the doctor and the patient. 8evertheless* personally* . never lie to the patient. "he should /now that . will do my best to improve her health* to save her life or at least to improve the quality of her life. #t the same time* the patient should be aware of the fact that medicine can never guarantee that things will go well. /here are situations where the patient ma# as) 0uestions a%out her health which #ou would rather not answer at a particular time and+ i$ so+ what do #ou do& .t depends on the question. .f the patient as/s how soon she is going to die* . always try to give the most accurate answer. 3or e-ample* ;<our health condition is serious* even you feel that it is worse than a month ago. . cannot promise you full recovery* but for how long you will live* it is only up to you. 6e can help you with pain* vomiting* diarrhoea* constipation* etc. .f you fight* you might have a chance to prolong your life. .f you give up* you might die very soon.= 3requently . add a story about one of my patients who was diagnosed with acute leu/aemia. #lthough she could not be treated medically because of her age* she did not live 1ust that one month more as she was predicted* but a full year* 1ust because she had enough mental strength to fight the disease. Does the seriousness o$ the patient(s condition a$$ect #our %ehavior& 7f course. .t really matters if a person comes with a cold* or if somebody has suffered a heart attac/* a stro/e or cancer. <et still it does not affect my understanding of any suffering. "ometimes it is sufficient to lend an ear* sometimes to give advice. 7ther times it is necessary to assure patients that we are here for them 9 not all the time* but in specific hours 9 and if they wish* they may come and as/ and tal/> *ith di$$erent social groups o$ patients+ do #ou use di$$erent conversational st#les& <es* . do. 7therwise it would not be possible to come to an agreement between me and them. "ometimes it is better to ma/e things simpler* sometimes to go into details. !owever* . always tell patients that in medicine nothing goes hundred percent. 6hat . also find useful is to compare human organs or medical systems to other* more approachable things* e.g. cars* household* nature* animals* plants. I suppose the answer to the 0uestions whether #ou are the %est ph#sician around is a resounding #es. .t is not so important for the patient to /now that . am the best specialist around. .t is important that she /nows that . have the best specialists at hand

and that . /now when to as/ for help and that . do so* i.e. that . do as/ when the treatment is complicated* when something is not clear to me. This way . show the patient how much . care about her 9 so much that . admit that . do not /now something* and . go to as/ 1ust because of her. Does #our nonver%al %ehavior di$$er with di$$erent ethnic groups& . do not thin/ so* definitely not intentionally. +ut to be honest* it is hard to assess as . do not have a lot of e-perience with these differences. I$ during #our conversation a con$lict arises+ how do #ou solve it& Do #ou utili-e humour+ $or instance& . utilize humour as part of everyday communication with my patients* i.e. during ward rounds* during reception and release of the patients. #s regards the way . solve conflicts* it depends on the particular type of the conflict* on what level it has arisen* whether the conflict has started as miscommunication between the patient and the doctor* or whether it is about faulty procedure on the part of the doctor. ?ersonally* . solve conflicts in a calm manner* . do not blame* . always try to find possible reasons why the particular person behaved the way she behaved. I )now #ou $re0uentl# have patients where the ris) $actors o$ the eminent operation are especiall# high. 'ow do #ou cope with the con$lict o$ the need $or telling the patient a%out this high ris) $actor and+ on the other side+ the resulting e$$ect o$ possi%le discouragement and hopelessness& <ou never /now all the ris/s. 2ost often . draw the patient5s attention to the most frequent complications and side effects* and . immediately continue with supplementary information on how we are able to cope with the problem. .f the patient gets frightened and wants to bac/ away from her therapy* . introduce an e-ample with ?aralen* where a certain amount of the drug will suffice to cause the death of any person. This e-ample usually persuades the patient to cooperate again@ she /nows ?aralen* has used it many times during her life and nothing disastrous has ever happened. !er hope is restored. I presume that these conversations+ these attempts to communicate and to esta%lish a human relationship with #our patient+ sometimes ta)e a considera%le amount o$ time. 'ow do #ou handle this& 'ow do #ou tr# to disentangle #oursel$ uno%trusivel#+ i$ the patient tal)s too much a%out su%.ect matters that are not germane to the issue& ust how do #ou get awa#+ i$ #ou need to+ i$ the patient wants to continue the tal)& 6ell* that is a tric/y situation. .t too/ me quite a long time to learn how to cope with such cases. +ut again* this is a matter of how you communicate with your patient. 6hat . commonly do is as follows0 . interrupt the patient@ then . apologize for interrupting her@ then . tell her that we have only a limited amount of time to sort things out@ after that . try to persuade her to give me clear information about relevant issues@ . convince the patient that we may tal/ about less relevant* private issues $e.g. family and 1ob problems) later on.

I understand that a hospital is a teaching institution as well. 1nd so we might %e interested in how #ou handle the presence o$ interns and residents in these conversations& 1re the# present+ while #ou converse with #our patients& /o what e2tent are the# involved& The presence of medical students ta/es two forms0 either as part of their seminar wor/ or within the bounds of their practical placement. uring the seminar wor/ students are under the supervision of their teachers and* because there is no time and there are always so many students $around 1A9B0) in the seminar* they do not participate in my rounds and interviews with patients. .t differs when they are on their placement. uring that time students attend my ward rounds and ta/e part in medical interviews. :ater on they carry out their own rounds* under my supervision* of course* and learn to treat some less demanding cases. #ll of that requires a significant amount of verbal interaction with their patients. In that conte2t+ are students o$ medicine taught the importance and techni0ues o$ communication with the patient& 1nd i$ so+ how are the# involved& #s far as . /now* school does not develop their communication s/ills much. uring the students5 placement the situation is a little bit better. !owever* to a large e-tent it depends on the supervising doctor and institution. "omewhere they may be given proper training in communication* elsewhere they even learn wrong communicative strategies. #s regards the future* . have heard that some medical faculties in the Czech %epublic are preparing courses with the aim of teaching medical students how to manage their time* how to communicate with patients* colleagues and nurses* how to rela-* how to specify priorities* etc. The courses will be instructed in an interactive way* imitating real-life situations and testing individual communicative s/ills. 1re #our nurses aware o$ what #ou are doing+ o$ what #ou are tr#ing to accomplish& /o what e2tent are the# cooperative& octor and nurse ma/e a team. .f one of the two components does not function* the team does not wor/ properly either. That5s why it is so important to learn to communicate not only with patients* but with nurses as well. 6hile interacting with a nurse* it is important to e-press how much you respect and appreciate their wor/. /o summari-e+ I would li)e to as) #ou i$ #ou $eel that in #our pro$ession at large there is enough awareness among teachers+ pro$essors+ concerning the importance o$ communications %etween ph#sician and patient. Is it emphasi-ed su$$icientl# in the medical schools& 8o* it is not. 1s a $inal 0uestion+ I would li)e to come %ac) to what we touched upon at the %eginning o$ this interview. 3an #ou reall# notice the medical %ene$its o$ what we sociolinguists call therapeutic conversation& <es* . can. iseases are psychosomatic* i.e. mind influences body and vice versa. The better the communication with the patient* the better the relationship with the patient* the better the psychological resources of the patient* the better the chance of the patient recovering.

3onclusion
7ne interviewer* one set of questions* two interviewees* two sets of answers0 not too much statistically relevant data* some of you may ob1ect. 8evertheless* if you compare the replies by . !. "evin with those provided by me* you will at least realize that they are more or less the same@ irrespective of the nationality or the time in which they were acquired. +oth of us strongly agree that ;the success of any form of treatment will very much depend on the patient5s participation and the quality of communication and trust between the patient and her physician= $"evin C "evin 1'('0 2D(). This supports the idea presented and elaborated* among others* by EernF in his series of articles $200G* 200(a* 200(b* 200(c* 200(d* 200') on the topic concerned.

4iterature
EernF* 2. 200G. 7n the 3unction of "peech #cts in octor-?atient Communication. Linguistica ONLINE A $2iscellanea .)* 200G* pp. 1-1D. .""8 1(01-DBBA. EernF* 2. 200(a. 8otes on the .mportance of octor-?atient Communication %esearch. .n TomHI/ovH* %.* 6ilamovH* ".* !op/inson* C. $eds.). Ends and Means in Language. 7strava0 ,niversity of 7strava* 200(* pp. 10-1B. EernF* 2. 200(b. # 3ew %emar/s on the !istory of octor-?atient Communication %esearch. .n Plurality and Diversity in English Studies. ?rague0 Charles ,niversity* 200(* pp. A0-A'. ."+8 'G(-(0-G2'0-BJG-J. EernF* 2. $200(c). 7n the 2anifestation of 8egative ?oliteness in octor-?atient .nteraction. Discourse and Interaction 1 $2). +rno0 2asary/ ,niversity* 200(* pp. B1J2. .""8 1(02-''B0. EernF* 2. $200(d). "ome 7bservations on the ,se of 2edical Terminology in octor-?atient Communication. SKASE Journal of ranslation and Inter!retation B $1)* 200(* pp. B'-DB. .""8 1BBA-G(11. EernF* 2. 200'. "truggles and Compromises within the 2ethodology of octor?atient .nteraction %esearch. .n Slova" Studies in English ... +ratislava0 Comenius ,niversity* 200'* pp. JA-D1. ."+8 'G(-(0-('1BG-DA-D. "evin* . !.* "evin* +. ,. 1'('. .nterview with a Kynaecologist 7ncologist on octor-?atient .nteractions. .n von %affler-&ngel* 6. $ed.). Doctor#Patient Interaction. #msterdam0 Lohn +en1amins* 1'('* pp. 2DG-2GJ.