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.