Frustration

What's more disturbing, a frustrated patient or a frustrated oncologist?

I only bring this up because I had one of those days at work today where it seemed legions of smartly dressed nurses, secretaries, pharmacists and lab techs were conspiring to drive me insane with their bureaucratic edicts all designed to obstruct my plans to deliver proper medical care [Waaa! The poor widdle kid! -Ed.] Now in the comfort of my home I realize I have violated Rule Number Four of the House of God:

"The patient is the one with the disease."

As penance let me share my view on the top reasons why patients get frustrated - the heck with doctors. When patients get irked it is usually because they are not getting information, time, service, empathy or expertise. Here's what I mean:

Information - this means communicating the diagnosis, prognosis, treatment options, goals of treatment, alternatives to the proposed treatment, risks and side effects of treatment and the limitations of therapy clearly and in plain English. This cannot be emphasized enough.

Time - rushing through an office visit is an open invitation to get fired. Making a commitment to care for cancer patients takes time, and not just because the disease is deadly, erratic and complicated to treat. Cancer is an emotional tornado and I feel it is my responsibility to give patients and their families enough time to work through the myriad issues spinning through their minds during a typical counseling session.

Service - returning telephone calls, examining x-rays, communicating with the other members of the medical team, keeping legible and detailed records, following up and more following up - some call it scut work, but in the world of cancer care we call it duty. It doesn't take long for patients to realize their doctor is a dud when promises go unfulfilled and chores go neglected.

Empathy - this goes without saying. No one wants an oncologist who lacks the ability to see the world through the eyes of the cancer patient.

Expertise - having a strong fund of knowledge, not just of medicine but of the most recent advances in diagnosis and treatment, is the most arduous task of the oncologist in my opinion. The science of cancer is expanding at an exponential rate and woe to those doctors who choose not to keep up. Research results are communicated with ease these days, if one would just take the time (that word again!) to do their homework. No patient wants to find out that they received a treatment last used during the Reagan administration.

I can handle those days when I get frustrated. What I can't accept is thinking that one of my patients is frustrated - from something I have done, or left undone.

More like this

Atul Gawande, in his book Complications, has some interesting things to say about the difference between a patient's expectations of medicine and the care they should receive and the reality of what doctors can provide. It's based on his New Yorker articles and I'd really recommend it.

Don't beat yourself up so much, doc. You deserve your feelings of frustration just as much as the next person, regardless. We all know that the bottom line and top of the list is always the patient in your practice, it shows in everything about you.

Lisa

What are you trying to do? Fill up every minute of your day and square inch of your office with cancer patients seeking a oncologist/partner such as yourself?

You'll never get a tee time in if you keep this up.

Thanks for your insights; your comments really hit home today.

I, too, did not get through as many patients today as my colleagues who do not see cancer patients. I was expected to make a quick recommendation based on the information contained in a pile of barely legible records. I spent precious time opening CT scans locked in incompatible formats on outside CD's. And, as also happened today, I tried and essentially failed to get a new patient to focus on the problem for which she was sent to me.

Happily, frustration is an anticipated part of the job; perhaps we can even welcome it. Dealing with cancer patients is a privilege even when they disappoint us by missing appointments, losing prescriptions for pain medications, or rebuffing discussions about smoking cessation. In those moments, we shake our heads and remember that the level of frustration could have been worse because, as Rule Eight reminds us, They can always hurt you more.

You forgot one source of frustration for cancer patients. Conflicting information and oppinions from their medical team.

Thanks for the post. A lack of communication is INEXCUSIBLE.

I recently had an MRI to check on my cancer. I'm waiting anxiously for the results to see if my cancer is back, how bad it is, etc.

I wait a week. Nothing. I call the oncologist's office. The nurse returns my call. She says, 'Oh, the doctor does want to talk to you about your results. You should fly down here (he's in a city some distance away). He says it's important he talk to you.

When's the next appointment?, I ask. A month from now. A MONTH!!! I say. I can't wait that long! I am anxious and concerned, and I have to wait that long???

I'm terribly sorry, she says, but he's out of the office for a medical conference (ASCO), and then something else means that he will not be back in the office until then. We are opening up a special clinic on that day, just for people like you.

Well, I ask, can you tell me what the report says? She says, the doctor really needs to talk to you himself; I can't give out any information.

GRRRR. I assume it's bad news, or else they'd tell me over the phone. Or he'd squeeze in a quick call, or leave the good news on my answering machine.

There are gradiations of bad news, of course, ranging from 'we need to run the test again' to 'I don't like what this shows' to 'It looks like the last treatment didn't work' to 'Do you have your affairs in order?'.

Why would I stay with someone like this? Because he's one of the world's experts in my cancer. I have to put up with unreturned calls from his staff, hours-late appointments (one to two hours, or more, in some cases), a lack of follow through (weren't you supposed to call me about this clinical trial application?) and so forth.

GRRRR.

I wonder if those thoughts occurs to my doctors... My surg. onc who I've seen great feedback from other patients and got some excellence in pt. care award totally failed to communicate with me, or the other doctors in the team.

It's one thing to not return calls... but it's another when they don't to do what they told me they'd do. I'd rather have them not do anything than tell me one thing turn around, and never do that.

I'm glad you care so much about your patients. I'm jealous.