Can cancer doctors cure their bedside manner?
by Amy Mastin
Fresh out of college and starting a new job in Indianapolis, newlywed Gina Nepsa was looking forward to a bright future in 1999. But at the age of 25, Nepsa was diagnosed with cervical cancer. In the same breath, Dr. Katherine Look told her she needed a hysterectomy and would never bear children. "It was a huge shock – and devastating," Nepsa says. "When you hear the big 'C' word, you immediately think the worst."
Nepsa says Look, her oncologist at Indiana University Medical Center, left the exam room as she cried. "Her bedside manner was very cold," Nepsa says. "There was no comforting."
Most cancer specialists lack empathy, reports a new study by Duke University Medical Center's Community and Family Medicine Department in Durham, N.C. Researchers documented 398 conversations between 51 oncologists and 270 cancer patients. When patients expressed concerns and fears, only 22 percent of doctors' responses included language to encourage the patient to continue talking.
"We recorded doctor-patient interactions and found that when patients expressed negative emotions, doctors didn't always respond empathetically," says Dr. Kathryn Pollak, social psychologist and lead study investigator. "The goal of the study was to assess how oncologists address patient negative emotion, and the results demonstrate a need to train clinicians to handle negative emotions when they arise. Oncology is a really challenging field, and in general oncologists haven't been trained in how to communicate with patients."
Even Nepsa's doctor agrees. "There are times when oncologists can shut down; we're human," Look told Angie's List Magazine. "Have I ever been perceived as cold and unsympathetic? I'm sure I have, and I regret it."
Look left her job in 2006 to join pharmaceutical giant Eli Lilly, where she designs clinical trials for cancer drugs. "I had uterine cancer in 1992," she says. "It never occurs to a patient that their doctor has been sick. I've experienced both sides. Oncologists are very busy and overworked. But we need to take time with patients and their families and tune in to all of their needs."
The National Cancer Institute estimates that Americans have a 41 percent risk of being diagnosed with cancer during their lifetime, and 50 percent of Angie's List members who responded to an online poll have cancer themselves or a family member who is ill. This group of diseases, characterized by uncontrolled growth and spread of abnormal cells, will cause one in four deaths this year.
The sheer number of cancer cases prevents some oncologists from getting too close to their patients, says Dr. Lidia Schapira, a spokesperson for the American Society of Clinical Oncologists and a practicing physician at Massachusetts General Hospital. "Cancer doctors have good intentions, but how much can they care and nurture in busy practices?" she asks. "Sometimes even people with good intentions, a lot of mastery and skill come across as detached."
Schapira says the Duke study serves as a "snapshot" of her profession. "It's always good to have a reminder that we're falling a bit short of our ideals," she adds. "We know that cancer is more than a disease. It affects the patient's family members, too. A caring attitude goes a long way. Human interaction is just as important as knowing the right drugs."
Jerry Roark of Houston feels oncologists are actually making progress when it comes to improving their bedside manner. In 1967 at the age of 25, he was diagnosed with melanoma, the most serious type of skin cancer. Upon entering the M.D. Anderson Cancer Center, he learned the disease had spread. He was hospitalized for two weeks as surgeons removed a mole from his right arm, covered the spot with skin grafts and removed two lymph nodes. "It was a terrifying experience for me," Roark says. "I didn't know what was going to happen to me, and they didn't explain it well."
Thirty-three years later, in 2000, Roark was diagnosed with prostate cancer. This time he had the confidence to ask questions and learn about treatment options. He had his entire prostate removed and spent just three days in the hospital. The world of oncology had become a "more nurturing community," he says, now 66 and cancer-free.
After getting a second opinion from her gynecologist, Nepsa and husband John asked Look to remove only part of her cervix. "Even though she lacked bedside manner, I felt she was a competent surgeon," Nepsa says. Look agreed, and Katrina Elizabeth Nepsa was born in November 2001. When Gina's cancer returned a month later, Look performed a total hysterectomy. Today, both doctor and patient are cancer-free.