What is proper etiquette for the newly diagnosed cancer patient/doctor relationship?
I received a phone call yesterday from a young man that was newly diagnosed with prostate cancer from the southeast.
He was interested in robotic surgery and had several questions.
He told me he found a local urologist who performs robotic surgery and asked me what kind of questions he could ask. He was turned off by his primary urologist who he felt, was not interested in speaking about robotics.
Among the questions he asked me was "Can I ask the robotic surgeon how many of these operations he has done?"
That got me to thinking about what are proper questions to ask and what are proper things a physician should do?
The specifics of my thoughts will be for prostate cancer, but the generalities can be diagnosed for many cancer, surgical, and other medial problems.
I personally perform about 6-10 consultations per week for newly diagnosed urologic cancer (mostly prostate, but also bladder and kidney, and less often adrenal and testis.)
What I usually tell patients is that they should feel free to ask anything. They can also interrupt me if they need to without worry while I am speaking.
I think the number of a certain procedure that someone performs is fair. I think how old they are is also fair. Board certification, how long they have been in private practice, and any question is OK to ask.
I recommend patients come in with their families and to take notes. Several patients have had recorders, which I personally do not like very much, but do let patients record our consultation if they choose.
I am open to discussing any therapy for their ailment. For example, for my newly diagnosed prostate cancer patients, we discuss watchful waiting, hormonal therapy, surgery (concentrating on open and robotic (touch on laparoscopic non-robotic); radiation (XRT, seeds, combination, and now cyberknife as a local hospital is advertising it); cryosurgery and HIFU (which is currently not approved by the FDA in the US).
I have had one experience I did not appreciate. I was helping my partner with a patient of his who had a few questions for me. The patient stood up and stepped into my personal space (about 6 inches from my face) and asked me a direct question while staring at me. He explained later he wanted to look into my eyes to see if he believed my answer, regarding whether I could perform his complicated surgery. I did answer questions for about 5 minutes after that.
Other than that, I do not recall being bothered by any question, and if I feel it is irrelevant, may choose not to answer a question, but am not insulted by it.
I also do not have a problem referring patients to different institutions or for different therapies than I can not provide. Our group has not performed an open prostatectomy in over 2 years, so if someone wants an open operation, I refer them to a few excellent open surgeons in our area.
My goal is to make the patient and his family feel as comfortable as possible and choose the therapy or surgeon that they feel most comfortable with. That being said I do, as most physicians do, recommend the therapy that I do best: robotic surgery for prostate cancer. I provide a secure email and ask patients to call or email me if they have any followup questions.
I also suggest second opinions as I believe it helps a patient have more than one opinion on their problem. I often give out the name of a radiation oncologist who I trust, but sometimes a medical oncologist if that would be beneficial.
I also give out the names of 2 robotic surgeons that I would go to if someone in my family had prostate cancer if asked.
I give patients the option of speaking to 2 patients of mine that are similar to them in age and preoperative medical condition. This allows them to speak to someone who had what I expect to be a similar experience. Having a 73 year old man speak to a 53 year old man will not help very much, but he should speak to someone who is in his 70s.
I would welcome input from other physicians and patients about their feelings on this topic, as I am sure my views are not the only views.
Posted by Domenico Savatta, M.D. | Permalink
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