Feb 27, 2009
The Straits Times
By Dr Ang Peng Tiam
This could very well be an apocryphal tale, but I have a suspicion it is more true than false. When Mrs Lim, a 79-year old lady, first noticed a lump in her left breast in 2006, she went alone to see a doctor who was introduced to her by a friend.
She recalled that he had told her: 'Call your family. You have cancer and you need to have surgery to remove your breast.' That message frightened her so much that she ran away and did not seek further medical advice about the lump.
She committed her illness to God and prayed fervently for divine healing. She tried all sorts of Chinese herbal medicine - lingzhi, pian zi huang and others - but to no avail.
By Chinese New Year last month, her left arm was swollen because of lymphedema (accumulation of fluid in the soft tissue). This is caused by destruction of the lymph nodes in the armpit by the cancer cells.
By this time the lump was bigger than a golf ball and could be seen if one looked closely at it. There was an unusual bulge above the breast on the left side, as if something was stuffed into the bra.
She finally revealed her illness to her family.
When she came to see me, it took me more than an hour to convince her of her illness and the need for treatment. She had an aggressive hormone-receptor negative breast cancer that needed targeted therapy.
With the help of her five children, I managed to convince her that her cancer was treatable. After one cycle of treatment, her cancer literally melted away like ice on a hot stove. 'God is really good,' she exclaimed.
I have no doubt that there is divine intervention in cancer, as with other inexplicable areas in life, but there is also a place for something more prosaic - like good communication skills.
I do not know who the doctor was who first saw her. I cannot even be sure that the account of that consultation is accurate. However, there is a lesson all doctors (including myself) can learn from this.
At every contact, especially the first, we have to be careful about what we say and how we say it. It sometimes does not matter how well-intentioned our words are but what counts is what the patient understands and what he takes away from that often brief visit.
Mrs Lim's tumour was probably not as advanced 21/2 years ago. Now, the cancer has already infiltrated the skin, involved the lymph nodes in the armpit and spread to the liver. In other words, she now has Stage 4 breast cancer.
It was pointless to consider surgery and her best option was to have palliative chemotherapy to treat her disease. While the chemotherapy has melted the tumour and she may even go into remission, her cancer cannot be cured. It will eventually recur.
Communication is such an important part of medicine. Yet, I really do not remember being coached on how to talk to patients when I was in medical school. We were left to learn by observing how our teachers interacted with patients.
I hope that things have changed and that the present curriculum does emphasise the importance of communication.
There is no one 'best' way to talk to a patient. It is not always necessary to tell all the 'bad news' at the first sitting, especially if the patient has come to the consultation alone.
The doctor must remember that the patient may never come back again. That is why it is important to keep the door open for the patient to either come back to see him or perhaps see other doctors so that care can be continued.
The care of cancer requires a great deal of understanding about the psychology of the patient. Each one is different.
Some want the facts without the icing. Others want lots of pampering. That is why it is important, in the selection of medical students, that we go beyond academic grades and emphasise 'emotional quotient'. A doctor must be able to assess the situation quickly and know how to make the patient feel comfortable.
When it is a question of life and death, when questions are unasked which nonetheless need to be answered, when obvious truths prefer to remain unsaid, you need to know that the patient has understood you perfectly.
Dr Ang, the medical director of Parkway Cancer Centre, has been treating cancer patients for nearly 20 years. In 1996, he was awarded Singapore's National Science Award for his outstanding contributions to medical research.
This article was first published in Mind Your Body, The Straits Times.
No comments:
Post a Comment