Prof Carol-Ann Benn differentiates between Dr Dolittle and Dr Do-a-lot with regards to communicating information.
You can listen to this article below, or by using your favourite podcast player at pod.link/buddiesforlife
While on a plane, I watched Doctor Dolittle. What a cool concept: communication (or failure to do so). This concept has been written about since The Tower of Babel to Avatar.
As an anxious traveller, I’m aware how stressors, major or minor, affect the ability to hear and listen. For someone just diagnosed with cancer, hearing what the doctor is saying and processing the information is difficult. The doctor also needs to have a skill in communicating medical jargon and information that will require you, the patient, to consent to in a time of stress.
The ability to relate to people issues isn’t a talent that the medical fraternity is renowned for. So, how can you decipher the medical information when the doctor is explaining words like malignant, sentinel lymph node biopsy, or mentioning names of drugs and treatments that are foreign to you whilst you’re frozen on the word cancer?Â
The Dr Dolittle theme is all about the ability to talk to animals and this doesn’t mean that your doctor should speak to you as if you’re an animal (rather think of the doctor as a different species or a person speaking an unknown language). What techniques can you use as Google Translate for processing your medical information?
Learning how to break bad news
Hopefully this is read by medical personnel as well as patients. The need for medical training in how to communicate is usually around lectures, such as breaking bad news. Whilst much has been written about medical communication; there is a lack in educational institutions teaching healthcare workers the nuances of communication. Often in medicine, different personalities chose different specialities, or the specialities chose them based on their personalities.
When I have the privilege of speaking at the medical students’ graduations I often explain that there is a place for anyone in medicine. The gynaecologist who wants to find the answer in small places. The pathologist who uncovers the answer in small bits. The oncologist who isn’t the life and pull of the party, and Freud’s analysis of surgeons, as the closest to psychopaths, isn’t pretty.
Yet as doctors, one of the most important jobs in medicine is relating the unrelatable, explaining the unexplainable, conveying the non-conveyable. How to decrease suffering by explaining disease processes yet not create so much fear that the patient wishes to climb on a party ship and party hard for six months then jump overboard.
Not all help is helpful
Using quotes from Dr Dolittle, let’s understand the importance of medical communication.Â
“I’m only trying to help” – Whilst an important concept of how we should all lead our lives; trying to convey an honest yet not overwhelming message doesn’t detract from the basic premise of: are you equipped to provide that help. Not all help is helpful.
An example is when your GP or radiologist kindly phones you (while you’re driving) and tells you that you have cancer, you need an urgent surgical consult, probably a mastectomy then chemotherapy and radiation.
Remember, different medical personnel will explain results based on their understanding of what they feel is the correct approach for you. As medical personnel, we are obliged to participate in continued professional development (CPD). Most of us, however, attend and read around our interests.
We explain according to our background, or fears and desires. “I face the darkest night” – This is applicable when you hear that you have cancer. Cancer is probably the hardest words for you to hear; trying to decide your medical choices whilst digesting a diagnosis is probably close to impossible. How to interpret the options amidst medical black noise, friend circle white noise, and other grey noise is near impossible.
As a patient (not my favourite word other than you need to be patient while waiting in waiting rooms) you need to know the potential problems and concerns regarding treatment and side effects thereof. But you also need to understand that once you have a diagnosis of a cancer, your aim should be to try your level best to ensure that the cancer doesn’t kill you.
Medical communication curses
Phone a friend. Find a quiet space and breathe. Hesitate; don’t run, and understand universal communication words that are swear words.
I insist you see – Don’t rush into referrals where you’re told you must only see this doctor or do this treatment with these specialists.
Urgent time frames – Whilst waiting weeks and months (procrastinating isn’t good), rushing into the first option given isn’t sensible. No patient with cancer should go from diagnosis to treatment without being given the option for other opinions and should have feedback from a robust multi-disciplinary team.
We need to cut it out to find out what it is – Today there are very few lesions that can’t be diagnosed with clever radiology and needle biopsies.
Bilateral mastectomy – Breast conservation has a better survival outcome even if you’re young, if you’ve a family history, and you’ve a cancer diagnosis. Treat the cancer; you can do your risk reduction surgery at a later stage, if you wish.
Axillary dissection – Today targeting a few lymph nodes is safer.
Start with surgery then we can look at chemotherapy – No start with a multi-disciplinary review then your treatment can be personalised.Â
If you do a mastectomy, you’ll avoid radiation (and chemo) – Capital NO! You can’t avoid radiation if there is cancer in your glands, and the biology of the cancer determines your oncology treatment.
Your cancer has come back and we’re giving you more chemo – If this happens insist on a repeat biopsy and a discussion in a robust multi-disciplinary meeting (with many independent senior oncologists).
The golden nuggets
Here are positive phrases that you want to hear from your team.
- It’s your body and you’re entitled to other opinions.
- You are welcome to go for a second opinion.
- Your cancer treatment will first be discussed in a multi-disciplinary meeting.
- You don’t need a mastectomy.
- Not every cancer needs chemotherapy.
- You’re welcome to take time with your decisions.
- You’ll be provided with cost estimates.
- We’ll work with your doctors.
A Dr Dolittle dilemma
When you’re with your doctors ensure that they and/or their staff are communicating the information you require in a way that you can understand it.
Often language differences, anxiety, and stress can result in processing less than 30% of what the doctor is saying. The medical team needs to listen to the verbal and non-verbal messages and cues that patients give around their fears, their concerns about treatment and side effects thereof, as well as the effect this has on them and their families.
Using analogies to help explain treatment options as the whys and the wherefores may often assist understanding. The value of the modern digital area is that we can assist patients by allowing recording of consultation explanations around cancer diagnosis and treatment.
I use an upfront communication approach by suggesting that I take a history, examine, and allow for my full suggestions and ideas as well as questions to be recorded.
When patients come for second opinions. I ask specifically for no information on what the first doctor found and suggested treatment until I have given mine, so as to avoid bias.
Offering online meeting consults and explanations that allow patients post initial in-person consultation to ask questions over a recorded digital platform in their home environments and not in the stressful environment of a medical consulting room helps avoid the stressors of a doctor’s consulting rooms.
Don’t make decisions in the doctor’s rooms; go home and digest the information. Sometimes medical suites are a bit like a jungle trip in Jurassic Park. Not the place for final decisions.
Do Dolittle dictionary
There are many words that are used in explaining cancer and treatment. Below are common ones that seem to confuse. The list is endless and if you don’t understand a word or phrase, ask for an explanation.
Malignant: A growth of cancerous tissue that is growing uncontrollably.
Tumour: A mass of tissue that may be non-cancerous or cancerous.
Breast-conserving surgery: An operation that doesn’t take your whole breast.
Breast reconstruction (oncoplastic): Fixing the hole left by the cancer surgery. Well recommended and doesn’t have to involve complex moving of tissue or using prostheses.
Sentinel lymph node biopsy: A removal of a lymph node (gland).
Radiation therapy: Daily treatment over a period of weeks where a small dose of ionising particles is given to tissue.
Chemotherapy: Drugs that kill cells that can be given orally or through a drip.
Psst! You bats. Show me the way out of here
There are many treatment options available and today oncology treatment is personalised and de-escalated. This means less people need chemotherapy and absolutely very few need a mastectomy. Find information and reading to assist with providing strength and courage for your journey.
Information that provides any easy solution that has no data backing from an unreliable source should never be trusted. WhatsApp messages about trying different YouTube solutions should all be verified.
Some doctors, like some animals, are not fluffy kittens. You may feel that you don’t relate or understand them. Remember, it’s about you getting the best treatment and sometimes means that the non-verbal communication feels like listening to a lion roar or a bird squawking. These excellent specialists who may not be domesticated don’t need to live with you but may provide the best care. Ensure in these circumstances you have a Dr Dolittle translator at all times.Â
Finally, as Dr Dolittle discovered, this humbling vocation teaches us every day that it’s only when helping others that we can truly help ourselves. Providing a common language shows compassion, respect, and an ability to understand a common goal of successful cancer treatment outcomes.
MEET THE EXPERT – Prof Carol-Ann Benn
Prof Carol-Ann Benn heads up an internationally accredited, multi-disciplinary breast cancer centre at Netcare Milpark Hospital. She has a professorship at University of Pretoria and lectures locally and internationally. In 2002, she established the Breast Health Foundation.
Header image by Freepik
