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The Patient-Physician Relationship

Conquest - Spring 2011


Case Worker Minette Famorca uses what she's 
learned through I*CARE to interact more confidently 
and positively with patients.
Photo: Karen Hensley

I*CARE builds the empathic side of oncology


By Lana Maciel

Conveying bad news to a patient or a patient’s family is one of the most challenging aspects of being a medical doctor, particularly in oncology.

It’s an emotional, stressful and sometimes uncomfortable situation for both the patient and physician.

But through MD Anderson’s Interpersonal Communication And Relationship Enhancement (I*CARE) program, doctors have access to numerous educational resources. These are designed to help improve their communication skills and make them more comfortable handling difficult discussions.

Interactive workshops, lectures and online educational courses teach basic and advanced skills for having conversations about end of life, the transition to palliative care, error disclosure and more.

The site also addresses how to:

  • be sensitive to patients of other cultures,
  • provide advice to patients who want to use alternative cancer treatments and
  • discuss options when cancer treatments are no longer working.

Led by Program Director Walter Baile, M.D., professor in the departments of Behavioral Science and Faculty Development, and Project Director Cathy Kirkwood, I*CARE offers approximately 90 online educational videos of different scenarios featuring doctor-patient interaction.

The modules also can be used to teach trainees.

Not only do these modules target the development of effective communication skills, but they also promote the physician’s ability to foster supportive relationships with patients.

“Emotions play such a powerful role in our relationship with patients,” Baile says. “There’s a lot of anxiety and sadness in bringing bad news to someone. What these modules teach is how not to let your emotions get in the way, yet still tell the truth.”

Shrinking the big elephant

But it’s not just doctors who benefit from the I*CARE program. Other staff members are also encouraged to attend workshops and take the courses that provide free continuing education and risk management education credits.

Module topics include how to:

  • disclose abnormal test results,
  • explore a patient’s concerns when they decline to accept a certain treatment,
  • address the question, “How much time do I have?”,
  • inform a family member of a patient’s death,
  • discuss clinical trials,
  • handle the situation when asked to continue futile treatment for a hopelessly ill patient and more.

The site has a special module, “On Being an Oncologist,” in which actors William Hurt and Megan Cole portray doctors and discuss their feelings about the stressors of caring for patients.

The goal of these videos, Baile says, is to help doctors “take that big elephant in the room and shrink it down” so it’s a more comfortable discussion for both parties.

“The scenarios cover a spectrum of conversations one might encounter in oncology,” he says. “We try to make it comprehensive by demonstrating effective responses to key communication challenges.

Walter Baile, M.D. (right), works with Greg West, 
director of TV Productions for UT Television, to 
produce videos that demonstrate conversations and 
encounters between physicians and their patients.
Photo: John Everett

“At the same time, we also want the program to be interactive and engaging so that doctors can not only see, but also be encouraged to think and reflect on their communication with their patients.”

One of I*CARE’s noteworthy productions is the “Crossroads” module, which won three Telly Awards in 2010 for excellence in video and online production.

In “Crossroads,” Robert Buckman, M.D., Ph.D., adjunct professor in 
MD Anderson’s Department of Behavioral Science, simulates a visit with a patient during which he has to relay news that her cancer has returned.

This series of videos shows different scenarios of the same conversation. Buckman demonstrates how his different responses at certain points in the conversation can affect the quality of the interaction, as well as the patient’s emotional reaction and acceptance of the news.

“It’s very rewarding to see people learn these skills,” Baile says. “It’s important for patients to know we’re there for them.”

The role of simulation

Perhaps the most interactive of the program’s offerings are I*CARE’s workshops. Participants present to the group a communication challenge they are experiencing. Then, they simulate the conversation through an enactment of the encounter by playing the role of the patient.

Dramatic role play helps physicians “stand in the shoes” of patients so they can better understand the patient’s feelings and emotional needs. It leads to a more effective approach to the real conversation.

“Putting yourself in the place of another person is very important. It’s a powerful teacher,” Baile explains. “When you experience what it feels like to be given bad news, it shines a light on the skills that are important to do it compassionately and effectively.”

Baile believes that oncologists and oncology staff can be therapeutic with patients beyond their technical expertise.

Listening to patients, acknowledging their concerns and being empathic when they receive bad news are methods of support within the scope of skills of every doctor. They enhance trust and confidence in the doctor-patient relationship.


© 2014 The University of Texas MD Anderson Cancer Center