Building Relationships with Your Cancer Team

What are your tips for good communication?

Much has been written about managing communication with your health care team. Good communication is critical to ensure that you get the support you need at a challenging time and your doctor gets the information she needs to manage your care. The focus is usually on interaction with your doctor, although there can be similar challenges communicating with others who are important in your care. You may not be aware that there is a great deal in the medical literature about communication. Doctors worry about this issue, too. It is important to remember that all of these relationships go both ways, and it is safe to assume that your doctor is also invested in a satisfying bond.

The catch is that you may define “satisfying” differently than she does.

At the BIDMC Cancer Center, a great deal of attention is paid to this issue. When patients come to us from other institutions, it is often because they have heard about our highly personalized care. This goes beyond clinical protocols to the human element. For years, I taught a course for our first year fellows called, "Everything you need to know about being an oncologist except the medicine." We discussed all of the most important psychosocial issues, but the primary topic was the doctor-patient relationship.

But at every hospital, oncology social workers talk with patients who are frustrated about their conversations with their doctors. The most common problem is feeling rushed during appointments. Other common concerns include not understanding what is being presented, worrying that something important is being withheld, feeling overwhelmed by information, feeling that the doctor is emotionally insensitive, dissatisfaction with systems or routines of the office, and, sometimes, just bad chemistry.

It is easy to remind you that you are the consumer, and that you are hiring your doctor. It is not so easy for you to feel that way. The realities of health care may mean that you have limited choices in selecting a hospital or physician covered by your insurance. The balance of power is inevitably very much on the doctor’s side, and it is hard to feel empowered and entitled when you are undressed and scared.

Here are some strategies that are likely to help you feel better connected and more in control in this important relationship.

1. Prepare for appointments and for phone calls. Make a written list of your questions, and start with the most important ones. Recognize that your doctor likely does not have time to go through three pages of questions at every meeting, so prioritize and organize.
2. Take someone with you to every important appointment. The extra eyes and ears and memory will be helpful, and it may be useful, too, to hear how someone else experiences your doctor’s words and style.
3. Ask early on what is the best way to reach her between appointments. Will she respond to emails? Will she herself or a nurse or Fellow return most calls? Don’t call with minor questions that can wait. Being respectful of her time will make her more respectful of yours.
4. Tell her a little about yourself. Force some normal social interaction. Your doctor should know that your daughter is being married next summer, and that your primary goal is to dance at her wedding or that your finances are very tight and you are worried about high medical expenses. Having information about your life will help your doctor relate to you as a “real person.”
5. Let your doctor know what your priorities are and remind her as necessary. For example, one of my patients frequently repeats her goals: to minimize the difficulties for her family, to minimize her own emotional and physical pain, and to make memories. This clarity helps everyone.
6. Your sense of safety and comfort with your care are most important. If you don't like, respect or trust your doctors, it is time for a change.