Every oncologist spends years learning how to treat cancer. Preparing ourselves to care for the full spectrum of our patients’ needs may not always be part of the curriculum. We begin our journey into the challenging world of oncology by studying tumor biology, biochemistry, radiology, and pathology.
We progress to garnering an understanding of the natural history of tumors, and eventually to mastering proficiency in therapeutic modalities including surgery, radiotherapy, and chemotherapy. As doctors who treat life-threatening diseases, we add supportive care and hospice to our coursework. Then we take the boards and enter into the clinic to begin our life’s calling.
Not enough time in our years of training, however, is dedicated to developing and understanding effective communication skills, or more simply, how to speak, and even more importantly, how to listen, to our patients.
The doctor–listening barrier
My personal lesson in listening occurred one day in clinic when, like all practicing oncologists, I was immersed in caring for several complicated cases; these were seriously ill patients. During a particularly hectic period, I was rushed into the examining room and said a quick hello to my next patient, Harvey S., a 62-year-old man with stage IV colorectal cancer scheduled to begin his second round of chemotherapy. Mr. S. immediately said, “How are you, Doc? Go ahead and take a seat.” I thought he was simply being kind, offering me a break on a busy clinic day.
“No, thanks,” I replied, “I’m okay, I’ll stand.” He repeated, “No, take a break and sit down.” Again, I replied, “No, I’m fine.” Finally, he looked at me and said, “Doc, you don’t get it. I need you to sit down and listen to me…please.” Only then did I hear what he was saying. It struck me that we know about the blood–brain barrier in certain chemotherapies, but on this day a patient taught me about the doctor–listening barrier.
Our patients can teach us valuable things.
Ironically, after years of medical school and rigorous clinical practice, a patient—not a professor, mentor, nurse, or colleague—taught me one of the most important lessons I learned as an oncologist. I couldn’t help but think about all the patients I had seen while moving from one exam room to the next, entering each room quickly, using my time efficiently, making a few key observations, taking notes, standing the whole time, and then leaving as quickly as I entered. I wondered how many of my patients felt as though I was not really taking the time to listen to their concerns.
Focus on the individual
To any doctor in practice or just beginning in training, I recommend that when you enter a room, be it in the office or hospital, find a chair, pull it up next to your patient, sit down, and look into the patient’s eyes. Nothing else, no other patient or issue you are confronting that day is as important as the seriously ill person before you. Patients may have waited a long time to see you. They may be anxious and frightened, or they may just have a story to tell. Our patients can teach us valuable things—some of the intricacies of personalized care we may never have learned in medical school or training—but in order to maximize our doctor-patient relationships and enhance our quality of care, we need to focus on the individual and make the time to listen.