Crossroads #4 Video Transcript

 

Interpersonal Communication And Relationship Enhancement (I*CARE)
Crossroads
Crossroads #4
Time: 6:45

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

 

Doctor:
Right now, we both wish - obviously we both wish - that this hadn't come back.

Mrs. Simpson:
Yes.

Doctor:
But it's come back after many years and because of the way it was originally -- the primary cancer when it originally presented, there is a good chance that it is controllable by hormone treatment now.

Mrs. Simpson:
I mean I guess that makes some sense. You know it's just been a really terrible few weeks.

Doctor:
Tell me.

Mrs. Simpson:
You know, the back pain it was bad enough. And then Dr. Stone, my own family doctor...

Doctor:
Oh your family doctor. Yeah, go ahead.

Mrs. Simpson:
Yes, he didn't even take me seriously. I mean he told me it was a muscle strain. A muscle strain and it is bone cancer now.

Doctor:
Obviously that's very upsetting to you.

Mrs. Simpson:
You know, you know what? I'm going to sue him.

 

Dr. Buckman:
Now that's an emotion. And here we are at another crossroad. So let's see, first of all, where a direct or factual response might have led the interview.

[ Music ]

Mrs. Simpson:
In fact, what really upsets me is that he said it was a muscle strain. A muscle strain, and it's cancer. You know what? I'm going to sue him.

Doctor:
Look, a lot of doctors might have made that same mistake.

Mrs. Simpson:
Yes, but you know he wasn't taking me seriously at all. He sort of just brushed me off.

Doctor:
Well look at it this way, back pain is actually very common whereas by comparison recurrence of breast cancer is much rarer than that.

Mrs. Simpson:
But I had breast cancer nearly 8 years ago. The moment that I had back pain he should have ordered that scan.

Doctor:
Well yes but look, in the sort of history of a breast cancer, I mean 3 weeks is nothing. Three weeks is not a long time. It wouldn't have made any difference to the treatment or anything else.

Mrs. Simpson:
Oh really?

Doctor:
Yeah.

Mrs. Simpson:
Really? So let me get this straight. If something really important to you got held up for 3 weeks like say your paycheck, that wouldn't bother you at all?

 

Dr. Buckman:
Answering so directly with facts can leave the patient feeling basically unsupported. But for something even less supporting, even inflammatory, let's have a look at an escalationary response.

[ Music ]

Mrs. Simpson:
In fact what really upset me is that he said it was a muscle strain. A muscle strain, and it's cancer. You know what? I'm going to sue him.

Doctor:
Look your doctor was simply doing his job. And a lawsuit is not going to get anyone anywhere.

Mrs. Simpson:
My doctor simply wasn't doing his job properly.

Doctor:
Well actually I think he was, yes.

Mrs. Simpson:
Listen I'm in real estate and I know about lawyers and all those sort of things. I'm going to make a complaint to the state board. And you know what? Then we'll see what's what.

Doctor:
Hear my advice. I really think this is not how you should be spending your time.

Mrs. Simpson:
Yes, well there seems to be a lot less of time lately doesn't there?

 

Dr. Buckman:
Now that wasn't unrealistic at all. Very quickly both the physician and the patient can sort of dig their heels in and become entrenched and basically adversarial. And that is the answer to the question, "Why don't you just tell her where to get off?" The answer is because it ends badly. And that does matter in the long run particularly in regards to litigation and in regards to complaints. As you may know, a very large number of complaints that - even the ones that reach just the level of the board - are precipitated not by medical actions, but by communication issues. So now, let's see how an open-ended question would have done.

[ Music ]

Mrs. Simpson:
In fact what really upsets me is that he said that it was a muscle strain. A muscle strain, and it's cancer. You know what? I should sue him.

Doctor:
Sue him? I mean just tell me a bit more about that.

Mrs. Simpson:
I can't think of anything but Dr. Stone saying it's a muscle strain and looking all smug and confident and just brushing me off.

Doctor:
I mean it sounds to me as if you feel that your opinion just simply didn't count for anything.

Mrs. Simpson:
Exactly.

 

Dr. Buckman:
You see how an open-ended question almost always leads to a better description of the feelings and then an empathic response really focuses the conversation. Now, were not talking about litigation, now we're talking about how angry Mrs. Simpson is actually feeling. So now let's see how an empathic response seems to get there even more quickly.

[ Music ]

Mrs. Simpson:
I mean he told me it was a muscle strain. A muscle strain, and it is bone cancer now.

Doctor:
Obviously that's very upsetting to you.

Mrs. Simpson:
You know, you know what? I'm going to sue him.

Doctor:
You're obviously feeling extremely angry. And I have to say that in these circumstances, if a cancer comes back most people feel angry and I think we all do. We can't -- it's very difficult to sort of get a hold of...

Mrs. Simpson:
So what you're trying to tell me is that what I'm feeling is normal?

Doctor:
In these very abnormal circumstances what I'm telling you is exactly right, that that's normal. One feels one wants to blame. In many respects, perhaps it would help both of...

 

Dr. Buckman:
And there we are. I hope that the theme of this module has come over clearly. When a strong emotion comes up and erupts basically, it needs to be acknowledged. And that is very often a relatively simple and straightforward technique. What I hope you've seen from these crossroads is that doing that framing of an empathic response in other words, is a choice. And it's a choice among several options and it's a good choice and one that will never let you down. I mean let's face it; our job in clinical oncology is very often difficult. And I hope that what we illustrate here helps make that job a little bit easier.

 

I*CARE Home