The Complex Physician-Patient Interaction: Expectations vs. Reality

Abstract

Facing a diagnosis of cancer can be psychologically devastating. The state of mind of most patients facing a catastrophic life event evolves through five stages: denial, anger, bargaining, depression, and acceptance [635]. In the denial phase, patients’ reaction often is “this can’t be happening, not to me”, which evolves to “why me? It’s not fair” characteristic of the anger phase. Then comes the “I’ll give anything for…” of the bargaining stage, followed by the “why bother” of the depression phase, shifting to “It’s going to be OK” of the acceptance phase. In cancer patients, the latter phase is often translated into a resolute determination to “fight” and “beat” the disease, which culminates in inner peace and the acceptance of death when it becomes clear that treatment has failed. Thus, it is not surprising that most patients opt for treatment: any treatment that offers some hope. This forward-looking fighting spirit, anchored on the primeval human instinct of self-preservation, often is bolstered by a subjective understanding of information disclosed by the physician, retaining positive elements while misinterpreting or unconsciously dismissing negative ones. Hence, in the US and some Western societies where “breaking bad news” has become an accepted practice, the physician must provide hope and emotional healing throughout the disclosure process. This can be accomplished by ensuring that the patient is ready to assimilate bad news, that information provided meets the patient’s wants, needs and preferences, and that the emotional impact of bad news is mitigated or retrieved by emphasizing whatever positive aspects of the case. Factors that can affect the patient’s understanding benefits and risks of treatment should be taken into account. They include the disclosure venue and timing (hospital, office, and context settings); the content of the disclosure (thoroughness, clarity, and specificity); and the level of personal interest and empathy conveyed by the physician [636]. Only then should the Oncologist formulate a management plan, taking into account the biological, psychological, behavioral, and social aspects of the patient’s disease and his/her input [637, 638]. The founder of the Schwartz Center movingly described his own experience with lung cancer only days before his death to illustrate the enormous power of caregivers’ empathy on a patient’s frame of mind [639].

Some see a hopeless end, while others see an endless hope.

– Unknown