Talking to a Patient
Authors: Frank L. Meyskens, Päivi Hietanen, Ian F. Tannock
Journal: Journal of Clinical Oncology (2005)

VOLUME NUMBER JULY J OURNAL OF C LINICAL O NCOLOGY T H E A R T O F O N C O L O G Y: When the Tumor Is Not the Target Talking to a Patient Frank L. Meyskens Jr, Pa¨ivi Hietanen, and Ian F. Tannock From the Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA; the Finnish Medical Journal, Helsinki, Finland; Princess Margaret Hospital, Toronto, Canada. Submitted October 24, 2004; accepted March 11, 2005. Authors’ disclosures of potential con- flicts of interest are found at the end of this article. Address reprint requests to Frank L. Meyskens Jr, Professor of Medicine and Biological Chemistry Director, Chao Family Comprehensive Cancer Center, University of California Irvine, 101 The City Drive, Route 81, Building 56, Room 210, Orange, CA 92868; e-mail: flmeyske@uci.edu. © 2005 by American Society of Clinical Oncology 0732-183X/05/2319-4463/$20.00 DOI: 10.1200/JCO.2005.04.002 SEND AND RECEIVE “It’s only a little spot.” I have cancer. “We can get it all out” They’re going to crack my chest. “The radiation only produces a little sunburn.” My neighbor got fried. “The chemotherapy isn’t bad” My mom barfed for days. “It’s just a small shadow on your spine” I’m going to be paralyzed, I’m going to have pain. “It seems to have spread to your liver but there is this new drug. . . ..” I’m going to be a guinea pig, I’m going to die. One fact, one reality. Two truths. One sent, one received. Frank Meyskens, MD COMMENTARY In this simple but poignant poem, the doc- tor tells the patient bad news using euphe- misms, belittling the seriousness of the message. The patient reacts to this by inter- preting the words in a most gloomy way. Neither the words of the doctor nor those of the patient represent reality. Those of the doctor reflect the well-intentioned, but mis- guided, policy of trying to protect patients by describing the effects of cancer and its treatment in gentler terms than are likely to be experienced; the patient responds with an exaggerated response that also misinterprets the effects of the disease and its treatment. Suppose that the words of the doctor and the patient were reversed. The doctor would then be seen as sadistic, because “truth” without empathy is cruel. Words form a limited part of the com- munication between doctor and patient. Here the interpretation and reaction of the patient suggest that the doctor’s words are thrown in the air lightly, creating anger in the patient. The content of the words might become more acceptable if qualified by ex- planation and delivered in a sensitive and serious tone that invited discussion of their meaning. The doctor must encourage rather than block the response of the patient, an- swer their questions and respond to them in realistic and understandable terms. It is im- portant for the doctor to express feelings and emotions, and also to recognize and acknowl- edge those of the patient, which may include anxiety, disappointment, grief, and anger. The patient needs information about their disease but also needs time and space for shaping thoughts about their situation. Per Salander interviewed patients with ter- minal cancer and, on the basis of his studies, introduced a concept called “creative illu- sion.” 1,2 This means that even patients with incurable disease who are aware of the seri- ousness of their illness need the possibility of dreaming and fantasizing about their future. This is not denial, but coping with the vicin- ity of giving up one’s life. It is possible for the doctor to tell the facts in a sensitive way and at the same time leave room for hope and illusion. Patients like doctors who are able to find words of hope in difficult situations. “Your mind and body are so strong despite Information downloaded from jco.ascopubs.org and provided by at UNIV OF CALIFORNIA IRVINE on December 22, 2014 Copyright © 2005 American from Society of Clinical Oncology. All rights reserved.