DiaLog: The Secret of Good “Person-Doctoring”

From OncoLog, January 2007, Vol. 52, No. 1

The Secret of Good “Person-Doctoring”

Robert Buckman, M.D., Ph.D., Adjunct Professor of Neuro-Oncology, M. D. Anderson Professor, University of Toronto

The oldest equation that describes the entire breadth of the clinical interaction is actually quite simple. It is this: Patient = Person + Disease.

In our clinical practice, we are not simply taking care of a disease process—we are taking care of a disease as experienced by a particular person.

We have all—appropriately—spent multiple years learning our “disease-doctoring” skills, and we are justifiably proud of our knowledge in managing, for example, node-positive, receptor-negative, HER2-positive breast cancer or recurrent ovarian cancer. The trouble, however, is that we almost certainly didn’t get any specific training in “person-doctoring”—and that poses a problem.

The solution to that problem is actually straightforward: we have to show that we see the patient as a person first and not simply as another case of “node-positive breast cancer.” Even though that sounds like a rather vague objective, there are some simple and straightforward guidelines that you can use right now which will help.

The secret of “making contact” with or “engaging” the patient is to acknowledge the emotion the patient is experiencing. Whatever it is they express—be it shock, disbelief, fear, anger, frustration, dismay, denial, sadness—it’s important that we as clinicians demonstrate that we have observed that emotion and that we note it as something that needs to be on the agenda between us.

The best and most practical way of doing this is called “the empathic response,” and it consists of three steps. Step 1 is to identify the emotion. Since emotions are almost always mixed, you can identify the strongest component. In Step 2, identify the cause or the source of that emotion—usually it is related to news you have just given the patient. Then, in Step 3, you respond in a way that shows you have made the connection between Steps 1 and 2.

For example, you might say, “This news is obviously scary,” or “Clearly this is difficult to believe,” or “What I’ve just said is obviously very upsetting.”

Any response that acknowledges and identifies the emotion will help the situation and label you as an effective communicator and part of the patient’s support system. Any response that ignores or invalidates the patient’s emotion (“You’re so brave—I know you’ll do fine!”) will probably label you as somewhat insensitive—and will make engaging the patient more difficult.

The empathic response is actually relatively straightforward. It simply requires an active decision to respond to the emotion in the room. If you aren’t using the technique very much at present, try it. I think you will be very pleasantly surprised at how easy it is and what a big difference it makes.

For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789.

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