By Kevin Begos

Relationship Building

What does it take to create a strong patient-doctor partnership?

By Kevin Begos

Collinsworth made a new appointment with her doctor. The doctor’s husband, who was in practice with his wife at the time, was the first to see Collinsworth when she arrived for her visit. Collinsworth told him about the e-mail. He replied, “Damn internet,” she says, and walked out of the room. His wife later came in and referred Collinsworth to a dermatologist, who confirmed that she had Paget’s. “After I was diagnosed, I called my doctor and said to her, ‘Please tell your husband that that damned internet probably saved my life,’ ” she wrote to CR in an e-mail.

Angiolillo says the important thing to remember is that there are good resources on the internet, but a lot of bad or just plain misleading information also exists on the web. “I think it’s great,” she says. “But there’s always this caveat: Come to me if you get confused. You need to let me help you get through this. There are too many ideas—too many internet sites. Sometimes having all the data in the world still doesn’t help get someone through the maze of this stuff.”

But the challenge of doctor-patient communication goes deeper than basic issues of listening or taking notes. The journal Patient Education and Counseling published a study in 2006 that examined encounters between physicians and 405 newly diagnosed patients with no prior history of breast cancer. The researchers, from Case Western Reserve University in Cleveland, found that the patients who asked more questions were those who were younger, were white, had more than a high school education, and had higher incomes. The researchers found that “providers communicate differently with patients by age, race, education and income” and that “these differences in communication may lead to disparities in patient outcomes.”

It seems clear that doctors need to be sensitive to a wide range of communication issues—though they can’t be responsible for everything. Patients may need special education or support, too.

But Angiolillo says both doctor and patient face another challenge that’s sometimes difficult to acknowledge: that cancer can be incurable, even with the best medical care. Her message to breast cancer patients that life will get better isn’t a reassurance she can offer every woman with the disease. “There are some people you can’t say that to,” she says.

Although some patients struggle to communicate with their doctors, Angiolillo says that, ultimately, going it alone isn’t really an option. Patients can do their own research and call on family or friends for support, “but they still need somebody to help them get through the health care system.”