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I'm Going to Mexico

The situation
The patient announces that she will seek alternative therapy for her lymphoma instead of undergoing the recommended chemotherapy.

Communication issues
Patients have a great deal of access to alternative treatment information via the Internet, and some of it may offer promise of non-toxic curative remedies. This may be a significant problem especially when the condition is potentially curable with conventional therapy. I'm going to MexicoOn the other hand, taking conventional therapy may be frightening for some patients, as well as unpleasant and hard to take.

While many cancer patients are interested in various kinds of complementary therapies, a rejection of standard therapy in favor of an alternative can be a very disconcerting announcement for a physician to hear.

This is not a totally uncommon situation in oncology today, but may be a highly-charged and emotive issue. It is very easy for the discussion to become bogged down in misunderstanding or adversarial stances when a patient rejects your recommendations in favor of ones you view as inferior.

What to watch for
Notice that the physician doesn't engage in a discussion about the proposed alternative treatment, but opts instead to explore the reasons for the patient's decision or desire to have unconventional therapy. He thereby discovers feelings, attitudes or experiences with conventional therapy which can be addressed empathically and with additional information. He also offers a compromise, which includes continuity of care, prevents the relationship from becoming adversarial and leaves the door open for future treatment.

View Vignette: I'm Going To Mexico (9:30)
Pearls & Pitfalls: Expert Comment (3:50)

 

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