By Laura Lee
The relationship between medical professionals and their patients can be a complicated one, as both sides need to operate with trust and openness. In a world where we can discover so many differing opinions through the internet, it can be hard to follow the prescribed path without wondering whether we are missing options by looking further afield.
Cancer is perhaps unique in having such a wide range of treatments and treatment options, which are developing all the time. Patients are also generally more informed about cancer and cancer treatment than they used to be; this is largely a good thing, but it can also be incredibly hard for patients, who are thrown into a world of unfamiliar language and often contradictory information, to make an informed decision about their own treatment.
The majority of people are still very accepting of the judgement of health professionals. However, we sometimes see people at Maggie’s who, for whatever reason, have decided not to have conventional treatment for cancer and have got into a difficult relationship with their oncologist, who can’t understand why they would eschew what is a scientifically proven approach to medicine. In these cases you often see a breakdown in the doctor-patient relationship. Sometimes, this might simply be an issue of the patient needing to talk through what’s happening to them, which they can do with our Cancer Support Specialists and other Centre staff. Time and space are often needed for patients to process what’s happening to them and make informed decisions.
As health professionals we have to present the scientific evidence and then support people to do what they want to do. But many oncologists have stories about patients who have wanted to pursue treatment that they regard as unhelpful, or even dangerous.
Ranjana Srivastava, an Australian oncologist, wrote a book called Dying for Chat, which argues that ‘good communication skills should be considered as important to healthcare as medical breakthroughs’. In one of her regular articles for the Guardian newspaper, Srivastava has written about one instance when a patient who, having run out of conventional treatment options, asked her to declare him fit to fly to another country for experimental treatment. Srivastava had grave concerns that her patient could be taken ill on the plane or that he may suffer if his condition happened to deteriorate when he was in a place without adequate medical care; but against this duty to protect her patient, she also felt she had to consider the suffering that might be caused by preventing him from pursuing what he saw as his last avenue of hope.
For doctors, it’s about how to stand up to – and stand by – our patients to give them the very best of medicine but shield them from the worst. For patients – when to question their own [decisions] and when to place their trust in ours.
This is a difficult balance to strike, but as Srivastava says: Health professionals need to keep in mind that patients will often want to fight on, even if the hope they perceive is very slim. Sometimes understanding this can go along way to helping patients through these very difficult times.