Suffering in Silence: When Doctors Fail to Ask The Right Questions


by Kevin Campbell

First posted on his blog on 02/24/2013

Kevin R. Campbell, MD, FACC

Let me start by saying that I am by no means an expert in Medical Oncology and I have great respect for what my colleagues in this field are able to do for their patients and their families.  From my earliest days of Internal Medicine training at the University of Virginia, I can remember the oncologists as being some of the most caring and compassionate physicians around.  However, recently I came across a remarkable article in the New York Times that gave me great pause.  Author Suleika Jaouad has been chronicling her battle with cancer in a regular blog.  In this particular entry, she describes her experience with dealing with the sexual and reproductive side effects of her cancer and its therapy.  Ms Jaouad brings to light the fact that often physicians fail to ask the right questions at the right time of the patient in their care.  It is not for lack of attention or concern but more often due to a laser-like focus on the task at hand–battling the disease.  In addition, in medicine today, most physicians (other than urologists and gynecologists) do a poor job of discussing sexuality and sexual side effects of diseases or treatments.  In her blog, Ms Jaouad remarks that she found it very difficult to discuss sexuality related issues with her doctors or staff–the subject never really came up.  Thankfully, she had a support group of peers to turn to.

As a specialty physician, I often find myself focused on one disease or one aspect of my patients’ health.  Sometimes, patients are crying out for help and we do not even hear them because we are wearing “blinders” as if we are thoroughbreds in the Kentucky derby. Too many times, we see the finish line of the race and forget to provide the necessary encouragement (and support) to the patient along the way.  Certainly there are guidelines and proven therapies for specific diseases–we all strive to provide the very best care.  But, as evidenced by Ms Jaouad’s blog, we sometimes fall short simply because we “forget to ask”. Or worse, we fail to pause and provide an environment conducive to TWO WAY communication when interacting with our patients.

So, what is the lesson here?  I think that for starters, it is imperative to LISTEN to our patients.  I have blogged many times about the importance of developing a positive and productive doctor patient relationship.  As we all know from our personal lives, one of the most important aspects of a relationship is effective two way communication. This is not always easy–patients may be intimidated by their disease or by their doctor–Doctors may be so preoccupied with their agenda for the day that they forget to pause for questions.  Either way, the opportunity for questions and attending to the needs that are important at the moment to the patient are lost.  A patient with a chronic or debilitating illness may have concerns that may not seem relevant to the overall treatment plan or disease battle to us as caregivers.  However,  addressing these concerns may make an enormous difference in the long run to the human beingsuffering with the disease.  As physicians, we are now under increased pressures for productivity and are asked to do more with less time–But we must remember to take a deep breath, and focus on what really matters.  More than anything, our patients need our care, compassion and concern.

I think that as healthcare professionals we must make it part of our routine to spend some time each visit making sure that the patient feels comfortable asking questions.  In order to facilitate this type of interaction AND ensure that our treatment goals are also met for the visit, we must make a real effort to incorporate time for questions into every visit.  In addition, we must remember that sexuality and sexual side effects of diseases and the treatments we prescribe are real and can have significant negative impacts.  We must do a better job of educating ourselves about these side effects and make a concerted effort to discuss them with our patients during routine office visits.  Although initial discussions may be a bit awkward for doctor or patient, it is important to open the door and invite communication to improve the lives of our patients who suffer with chronic disease.



  1. All valid points Kevin and they fail to acknowledge two important causes of listening failure that are inherent in the workplace. If you do the usual – which you do here in this article – and simply tell physicians, “you should listen better” … all I can say is DUH … and then let’s dig into why we don’t. We know how important listening is … there are environmental factors that make it well nigh impossible much of the time.

    1) Burnout. When a physician is not getting their own needs met (self care, relationships, rest) the first thing to go out the window is the awareness of other’s needs. Usually known as “compassion fatigue”, one of the key signs is rushing through the day, head down and focused on clinical concerns, just trying to make it to the point where you can punch the clock and go home. Burnout is incredibly common everywhere and all the time because of the sweatshop conditions in the front lines of care delivery in the majority of organizations. (see below)

    2) Systems interference at the point of care. If you have a work environment that gives you 10 minutes with the cancer patient mentioned above AND puts an EMR between you and them in the office visit … I am sorry, and her sexuality conversation is NOT going to happen. NOT because the doctor didn’t care. This is purely a systems and bandwidth issue. If I have 10 minutes, I am naturally going to spend it on making sure she does not have a relapse or life threatening side effect from her treatment. In this setting, a support group is the best place for her to get her sexuality questions answered.

    Whenever I hear, “Doctors aren’t good listeners” … I say poppycock. Burned out doctors in systems that starve you of patient contact time and put systems between you and and a quality patient encounter … those doctors don’t listen. 85% of this issue is systemic to the way healthcare is provided, NOT the doctor IMHO.

    Dike Drummond MD
    Over 117 ways to prevent burnout in the
    MATRIX Report