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>> Very few doctors have been
trained in how to talk
with their patients
about prognosis
or other emotionally difficult
topics and it is
such an important part
of giving good care.
Recently, a terrific oncologist
in Cleveland wrote a paper
called, If I Paint a Rosy
Picture, Do You Promise Not
to Cry?
And I think that sums
up a certain point
of view exactly.
And it's kind of a default point
of view because a lot
of clinicians I think are,
you know, they feel
like they are being kind
by not allowing people to cry
or not provoking people to cry.
But the reality is,
very often what they are doing
is they are fuzzing
over the truth in a way
that people don't quite see what
they are up against.
I am Tony Back and I'm professor
of medicine at the University
of Washington
and the Fred Hutchinson Cancer
Research Center
and I practice GI Oncology here.
My work in communication got
started when I was a medical
student and I would follow
around these really famous
oncologists on rounds
and watch them talking to people
and think there's got
to be a better way to do this.
I didn't feel
like we were always
totally honest.
I feel like we would have one
kind of conversation
in the hallway
or in the conference room before
we went into the patient
and a whole different kind
of conversation
with the patient.
Discussions
about prognosis are hard,
but I think they're a really
important component of trust.
How we as providers handle
difficult conversations can make
or break the
therapeutic relationship.
A lot of data showed
that the more we listen
and help patients say what's
on their minds the more
resilient they can be in dealing
with their illness.
And we as doctors
and other providers will
experience less stress,
less burnout if we know how
to communicate well.
My advice for doctors is suss
out what the patient wants
to know.
So, ask them,
you know are you a detail
oriented kind of person,
do you want the statistics,
or do you really want the big
picture and you want to know
about something
and how this is going
to really relate to something
in your life.
Don't fall into the trap
of thinking you haven't talked
about prognosis unless you've
talked about the statistics.
There are a lot
of ways you can get
to what people need to know
without giving them the median
survival and for some people,
the median survival will be
helpful and for other people,
it will actually be harmful.
So, that's where I feel
like the way we communicate
with people is part
of the treatment that we give
and part of the care
that we give.
I talk to a lot of,
especially trainees who feel
like people are
in denial all the time
and I think the more common
issue is that people want
to talk in stages
about where they are
and they are ready
to hear a different part of it
at different times.
So, I don't think
about that as denial.
I think about that
as it's too scary, right,
so my job isn't about breaking
down the denial.
My job is how can I make it a
little less scary
or how could I introduce parts
of it little by little
so that they can eventually get
the whole picture.
So, one of the things
that doctors ask me is what do I
do about the patient
who is hoping for something
that I don't think I can
deliver, right,
and you know my thought
about that is
that people are going to hope
for all kinds of things
and what I have
to do is make sure
that they can make some
responsible medical decisions
at the same time.
So really, there's kind
of this dual track thing.
I can hope for the best and plan
for whatever could happen,
and those two things aren't
mutually exclusive.
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