Good Doctors Listen

As I sat in my oncologists office last week a young first year resident entered the exam room. I was not warned by my oncologist’s nurse – very unusual. Yet I was not worried to see him either, since my oncologist certainly wouldn’t put someone in a room with me who wasn’t capable of good quality care.

The resident began his questioning and went through all my medications asking why I took certain things and who my primary care doctor is. Yet each time I would begin to give him an answer, within 3 to 6 seconds he would interrupt me and put in his $.02-$.10 worth of self important opinion-based advice. After about the seventh question I got kind of annoyed. He clearly hadn’t read my chart before he came into the room. He had never seen me before and didn’t know anything about me as a human being or my condition – I was just another generic cancer patient to him. Just another face In an exam room. Just another woman with metastatic breast cancer. And then immediately without really knowing the extent of my relationship with my oncologist he began questioning my current protocol – and making treatment suggestions.

He then pulled up the films of my last CT scan with contrast. Why he thought this was even appropriate is beyond my understanding. But I think it was also to clarify his understanding of where I was at before my doctor came in because again, it was obvious he had not reviewed my chart, which is something I can’t stand. Just as he was starting to review my last films, “okay I’m going to pull up your scan and show you what you look like inside.” (Had I accidentally gone to the children’s cancer center?) My discomfort grew. He had nothing to compare this scan with and no history with me at all. the following occurred making me not just uncomfortable but slightly angry.

Sometimes the filter between my brain and my mouth goes on holiday. It took a brief trip at that moment.

Clearly he knew nothing of what kind of patient I am and he didn’t understand the style of relationship beteen my oncologist and I. Just as I said the following sentence, “you know statistically most physicians wait an entire 13 seconds before they interrupt the patient. You’re waiting merely three seconds. I suggest you at least give me the full 13 seconds of listening while distracted by the computer before you interrupt me.” His mouth was agape with the audacity of my comment. Don’t you just despise when someone asks you a question and then doesn’t even listen for or to your answer and then begins talking over you?

The moment I said that Dr. B walked into the room and started laughing. He’d heard the comment that I made and proceeded to correct this young resident and told him that I was an unusually well informed patient: the kind of patient who understands their illness and that he and I both worked on my treatment, not just him. And that interrupting your patients is not a good protocol at all. The resident continued to bring up my films and Dr. B said please shut the screen and let’s ask Ms. Kaminsky if she would like to review the results before we just pull those films out. It might not be a good time for her and we should find out if she wants to talk about that or not.

Of course I wanted to talk about it and he knew that. We had already had a conversation via email reviewing what the appointment would entail – we were going to talk about the films and what the next steps were going to be because apparently things were not looking as good as we’d hoped. The resident sat quietly after that and he listened to our conversation. He did as Dr. B instructed, pulling up things on the computer screen when asked to and was quiet for the rest of the rather long 90 minute appointment.

The rest of the conversation when something like this. I asked Dr. B weather xgeva was the right medication for me to be on for so long because it was taking a toll on my bones. He said that was something we should definitely look at and I asked about a new substitute medication that’s also delivers bone support I had read about in a study. He had read about the same study although neither one of us could recall the name of the medication and I still haven’t looked it up because he’s going to do all that legwork for me or at least have the resident do the work. He will get back to me on that one.

Next we talked about what the CT scan showed and it turns out that I have a growth (can’t we just call it a tumor, which is what is) on my L4 vertebrae that is going to require something different. And we were both certain what that would be. I said “Dr. B I think it’s probably time we look at some radiation.” He retorted: “why do you always jump right to the end of the conversation and spoil all the fun?”

We laughed again. The resident didn’t laugh – he cocked his head like a dog who hears his name from his master.

Now that’s funny.

But indeed I had a hunch for that day’s outcome, since my lower back had hurt more than usual. It’s always given me trouble in the past, but this time it’s different and the pain is different.

I know the only real course of action is radiation therapy. It’s pretty standard procedure for these kinds of tumors. There will be a tattoo of a few dots on my back. My mind races to the reward of another tattoo after the treatments are finished. There’s one waiting for the scar on my right 1/2 a breast of a bird on barbed wire across the scar.

Any ideas for the dots on my lower back I’m taking suggestions. Snag a permanent place on my body with the best answer – and it cannot be a tramp stamp or a follow the numbers dot puzzle.

No paint by numbers either. Get creative and you’ll also receive a free copy of my book whenever I finish it. Gogs Gagnon’s book re-inspired me to hit the pages again.

Thanks to you, my readers and my friends for suffering through yet another day in the life of a metastatic breast cancer endurer (borrowed from Rudy Fischman who’s VLog The Brain Cancer Diaries which is worth any of your limited time. Start wherever in his series you’d like it’s non linear in a way since he interviews people with all kinds of cancer and doesn’t just hack on about himself. I think found him on YouTube around episode 10 and went back to the beginning – he’s at https://www.youtube.com/channel/UC1_GCferA7W2dr5WVP2rq_w)

I like endurer better than survivor. We aren’t going to survive our cancers but we do endure.

Indeed we do endure a lot.



14 thoughts on “Good Doctors Listen

  1. Hi Ilene,

    Your response to the resident was so Ilene. And that’s a compliment. As others have said, hopefully he learned from the conversation. What’s sad is that not everyone in similar situations feels up to doing what you did. A lot of patients just don’t have it in them for whatever reason(s). I’m glad your regular oncologist heard some of the conversation and that you two have a good relationship. I’m sorry you have to start radiation. Since you do, here’s to hoping it does its thing! May we all be better listeners. xo

  2. I agree that “endurer” is more relevant in our case than “survivor” – although I still favour something along the lines of “astonishingly and unexpectedly cured ex-cancer patient” – and yes, it’s so annoying when someone interrupts rather than listening and doesn’t actually take in what you’re saying anyway, because you’re not “qualified” to have an opinion! Fortunately I rarely come across that. I’m like you, Ilene – I speak my mind – and I love your how you describe the filter between your brain and mouth going on holiday!! 🤣

    1. Oh I have always had the mouth brain barrier problem. When I was little I ate more than my fair share of ivory soap to “wash my mouth out” but it didn’t work much to my mothers consternation. This resident surely did not understand me nor did he understand the benefit of the voice of the patient. Maybe he learnt a little big about both that day.
      Love you,
      Ilene
      PS I still wish you’d accept a small token of my friendship but I won’t press the issue anymore. It’s not exactly free you’d need to contribute 70 cents to shipping. That’s so I can use Etsy for discounted international shipping costs. Let me know if you change your mind. I assure you it’s not over the top expensive and it’s for you to remember there’s a person across the pond who cares about you and appreciates all the extra work you do.

  3. Hi Ilene, I am a general surgeon and have treated many cancer patients. Thank you for sharing your experience. I hope the resident grows in wisdom and humility. You certainly were an important part of that process.

    1. I hope so too. I wish that there were more oncologists like mine and I hope this resident learns how to listen and have empathy (not sympathy) and compassion from him. I know many patients are afraid to say anything about these experiences but if more would speak their truth more young doctors would learn to hear the patient’s voice. It’s one of the most important and difficult lessons that aren’t in their books. And thank you for sharing your encouragement and for reading. I am very humbled by your comment .

  4. Wow, Ilene, what an awful experience you had with the resident. I’m glad your oncologist heard your comment, and I sure hope the resident learned something while he sat quietly in the corner. Please tell me this is not typical, and residents are trained to listen to the patients. The one-way conversations must stop. We are not the disease, we are people with a disease, and we have a right to be included in decisions and treatment plans. I’m sorry to hear of your back pain and your upcoming radiation. But I’m so happy you are an informed patient. I fear for the countless others who simply follow doctors’ orders. Your idea of tattoos over scars is fantastic. I have several scars, and some very long. You got me thinking! I’m so glad my book was able to re-inspired you to write. Please put me down for a signed copy, and I’m more than happy to pay. I also have a YouTube channel, but not at the same level as Rudy’s. I’ll be thinking of you, my friend.💕

    1. Gogs you’re a true gift to the cancer community. Rudy’s been doing his vlog a long time and he’s very inclusive of other forms of cancer. He’s done an interview with warrior megsie and I have an upcoming interview with him as well. I will be sure to check our your YouTube channel and I am so glad to have you as a friend.

      Not all experiences are like this although I have to say interns and residents need to learn to hear the patients’ voices – we can give them some of the best information there is to learn and pushing it aside is a mistake. I had a worse experience with two interns trying to impress an oncologist at Stanford hospital during my stay in 2019. I had to throw them out of my room as they argued over who would do the notes and ask me questions so when the physician showed up they would look good to her. I had news for them: they looked terrible and obnoxious and immature. There’s a few days of instruction on listening to patients and it’s glossed over so I hear. I think it should be a semester long course taught by the patients themselves.

      P.S. I’m always available for interview if you’re looking to include other kinds of cancer experiences in your vlog 😉

      1. Illene, you are so kind! I also have an upcoming interview with Rudy. It would be an honour to interview you for my YouTube channel. You opened my eyes to finding ways I can help raise awareness of other cancers. I’m such a newbie!! Give me some time to get organized, and I’ll send you a private message. I’m glad to hear that not all experiences with interns are one-way conversations. But I do think that two days’ worth of training in the art of listening is not enough time.

    1. I appreciate your thoughts and I miss “seeing” you online. I too draw spirals all the time and the labyrinth is in some ways a spiral – it’s not a maze but you ask a question and meditate on it as you walk through the labyrinth. There’s one way in and out, like the spiral. The universe is full of spirals as is our body – the inner ear is a spiral and perhaps listening has a great deal to do with that universal shape. Love you and hope all is well in your world. One day we will have to chat on the phone.
      Oh
      and #fuckcancer

  5. We always gave the physician a run down prior to the physician entering the patient’s exam room.
    Any and all results always ready, how the patient was feeling, any changes since previous visit Etc.
    In your case I would have said to the newbie. Mrs. Kaminsky is very pro-active and well informed as to her illness and her medical treatment. She’s highly intelligent, and I suggest you tread lightly as she has a great sense of humor but don’t insult her intelligence with stupidity as she will no doubt put in your place.
    I hate dismissive/ inattentive healthcare providers that do not do their homework and walk into an exam room blindly as if it no big deal. It is a big deal – it’s your life.

    1. You’re a special nurse Jan. The patients in your office always loved you and it was not a mystery as to why they called you when they needed someone to listen to them. You made the office a place to feel cared for and heard.

      As for this resident I hope he learns to be patient and hear the voice of the people he treats especially during such trying times. I suspect Dr B threw him into the lions den with me purposely to learn a thing or two about the value of listening to the very reason you became a doctor in the first place. Part of healing and “causing no harm” as the Hippocratic oath states is hearing and acting on the patients needs. It’s the reason they exist or we’d not need doctors!
      I love you!

    1. Kristie I certainly hope so! Thank you for continuing to visit my blog and hear what I have to say!
      ❤️ stay sane in strange times.

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