Crossroads #3 Video Transcript

Interpersonal Communication And Relationship Enhancement (I*CARE)
Crossroads
Crossroads #3
Time: 5:39

Robert A. Buckman, M.D., Ph.D.
Adjunct professor, Behavioral Science
The University of Texas M. D. Anderson Cancer Center

Mrs. Simpson:
Yes. And then there's, these, this same thought going over and over in my mind.

Doctor:
Go ahead. Tell me. Tell me what's going through your mind.

Mrs. Simpson:
If the cancer's come back after all that treatment, and after all this time, then really all of that chemo, and all of that hormone treatment, it really just wasn't worth it, was it?

Dr. Buckman:
So here's another crossroads or option point if you like, the patient is basically saying that the adjuvant therapy wasn't worth it. And again there are several options. Even though your first thought, as mine was,was probably grounded on the survival advantage to adjuvant therapy compared to no adjuvant therapy, particularly chemo followed by hormone therapy in ER positive, PR positive tumors. So, here's how a direct response might have led the interaction.

Mrs. Simpson:
It just wasn't worth it, was it? I mean all the hormone treatments and chemo. In the end it just wasn't worth it.

Doctor:
Well, actually it was worth it.

Mrs. Simpson:
Why?

Doctor:
Well, because we know hundreds of thousands of women with breast cancers, just like yours, have had the treatment and have done better on average, than people who have not had treatment. So, honestly we can say, who knows where you'd be and how you'd be if you hadn't had the therapy. See what I'm saying.

Mrs. Simpson:
I mean I hear what you're saying but it just doesn't feel like that to me right now. I thought all of this was behind me.

Doctor:
Well, even so.

Dr. Buckman:
With that direct or factual response the patient is left with that feeling that she hasn't been heard. As the old saying goes, you gave me the facts, but not the truth. Even so, as I said there, a factual or a direct response is certainly better than basically escalating into an argument. As we're going to see with the escalationary response. Let's watch.

Mrs. Simpson:
It just wasn't worth going through all that chemo and hormone treatment in the first place now was it?

Doctor:
Now look, we do our best here. And there are many hundreds of thousands of women all over the world who had the same kind of treatment you had and have done actually better than people who had no treatment. I must admit sometimes the treatment doesn't work and I'm really sorry for that. But look at it this way, you've had some good years and that should be, that should be a very, very positive thing to think of.

Mrs. Simpson:
Hmm. Funny enough that's not much of a consolation right now.

Doctor:
Well there it is. Those are the facts. You had good treatment and I'm really sorry that it didn't actually last for longer.

Mrs. Simpson:
You're sorry? Well I'm a lot sorrier than you are.

Dr. Buckman:
Again, not acknowledging the patient's very strong emotion quickly leads to an impasse, a standoff. So now let's see how an open ended question would have faired.

Mrs. Simpson:
It just wasn't worth going through all that chemo and hormone treatment in the first place, now was it?

Doctor:
Why don't you tell me more about that?

Mrs. Simpson:
Well...

Doctor:
Huh?

Mrs. Simpson:
It just feels so hopeless.

Doctor:
Hopeless?

Mrs. Simpson:
Yes, I mean I thought I had a reasonable chance that it wouldn't come back at all or maybe after a longer time.

Doctor:
You sound as if you're running really low on hope, right at this moment.

Mrs. Simpson:
At this moment, yes, I am running really low on hope.

Doctor:
I, I understand that, what you're saying. Maybe it would be helpful if we talked about the actual concrete plan about how we're going to control the disease.

Dr. Buckman:
As you saw there the whole point about an open-ended question really is that it's not actually an alternative to an empathic response because so often your next communication is indeed an empathic response. There you saw the oncologist repeat the word hopeless in order to better understand what the patient really meant when she used the word hopeless. So now here's how an empathic response might work, if it was the first reply that you gave to the patient.

Mrs. Simpson:
All of that chemo and all of that hormone treatment, it really just wasn't worth it, was it?

Doctor:
I know that's very disappointing...

Mrs. Simpson:
Disappointing?

Doctor:
Yes. I do understand how disappointing it is. But actually the treatment did do something. Perhaps I can try and explain that. Can I try and explain it?

Dr. Buckman:
Again, that empathic response worked and as you saw before it, the exploratory response also worked. Now you could almost think of empathic responses as techniques that hit the target. And you can think of exploratory responses as range finders, that help you locate the target so that your aim is more accurate.

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