By Kevin Begos
What does it take to create a strong patient-doctor partnership?
By Kevin Begos
What do you say if every word concerns a matter of life or death? Under that kind of pressure, it’s no wonder that some breast cancer patients and their doctors struggle to communicate. There’s the possibility of saying too much and confusing the situation. Or too little and leaving out a vital question or piece of information. Or even hearing all the right words but feeling so overwhelmed that they just don’t register—the important messages drifting off to sea as you watch from the often-lonely island of cancer.
But words can be a comfort, too, easing the difficult path of diagnosis and treatment. CR magazine talked with several patients and their doctors about what type of doctor-patient relationship works and what kind doesn’t. Gail Kazin of Sudbury, Mass., still remembers how her primary care doctor started things off in exactly the right way. “It will be a hard six to 12 months and then you really will be OK,” Dea Angiolillo told Kazin, just after her diagnosis with stage I breast cancer in December 2003. Kazin immediately felt hopeful and optimistic—this was a doctor she could trust. Looking back, Kazin says that Angiolillo “didn’t at all say it was going to be easy. She was totally honest.” The doctor’s line was so concise and memorable that one of Kazin’s friends, a nurse, immediately picked it up to reassure other patients.
Angiolillo, of Wellesley, Mass., says she has used the words many times in 25 years of practice, and probably came to them after seeing patients at different stages of treatment. When people are in the middle of chemotherapy or radiation, “it’s very hard to see the forest for the trees,” she says. “All you know is you feel lousy and you have six more sessions to go. It’s very hard to get beyond that.” But over the years, Angiolillo came to realize that she also sees the same patients months or years later. “Their lives had gone on. They went to France, they went to grandkids’ graduations.”
Knowing the personal details of a patient’s life is often the foundation for having difficult talks about cancer, Angiolillo says. “The more I have a connection with an individual patient, the more I feel I’ll be able to help them. Different patients want and require different communication.” Relevant issues include whether the person has a support network, is religious, or is likely to want to read articles about their disease. “A new patient—it’s harder,” Angiolillo says. Though no matter what, “My big thing is you’ve got to be honest. You’ve got to be up-front. Patients need to know communication is wide open.”
That wasn’t what Wanda Schiavone of Orangedale, Fla., went through during two rounds of chemotherapy—for breast cancer that was diagnosed first as stage IIB and then as stage IV—in late 2004 and early 2005. She was full of questions and anxiety, in part because mammograms and ultrasound had missed her tumor for almost three years. But Schiavone says that when she peppered her oncologist with questions, the response was: “Because I said so. That’s my medical degree on the wall.” The friction grew, until one appointment during which Schiavone questioned whether a mammogram or magnetic resonance imaging (MRI) was more appropriate. The doctor, she says, “took my chart, threw it down on the floor, said ‘Do whatever you want, get an MRI,’ ” and stormed out of the room, slamming the door behind her. “She just left me,” Schiavone says. “It was just very, very bizarre.”