Patients are being invited to ask questions and voice their concerns more these days, and it can be eye-opening to the medical providers. I was with a surgeon who was doing her final pre-surgical review with a patient, and the questions the patient’s family asked made her step back and realize she needed to explain the surgery over again from a whole new perspective. The doctor had come in presuming the patient and her family had understood everything just fine at the office visit, but the questions that came up when I was with them told a much different story. It was illuminating for all concerned to share this question and answer session. I am glad to see this happening as a more regular part of healthcare.
When asked if she understood what was going to happen during the surgery, the patient admitted she really didn’t know what her body parts were that were slated for removal. Just that they were “down there”. So the doctor was able to make a simple drawing, and instead of just naming items like ovaries, womb, bladder and bowel, she showed their shapes, and said what each organ does, in a simple way.
The husband’s main concern was whether any men would be in the operating room. He was very concerned about his wife’s modesty. The surgeon was able to reassure both him and the patient that she would be covered up and that everything would be done “decently and respectfully”.
The son said he was really surprised to hear that his mother had two ovaries, because he had always heard that women just have one. The doctor was able to explain that the gonads in both men and women, that is to say, both ovaries and testicles, come as a pair. In men, they descend and hang outside. In women, they stay deep inside. She pointed to her drawing to show where they were. She explained that is not where the baby grows, and we do just have one womb. She pointed to that as well.
The daughter, a college student who is bilingual, asked if after the doctor removes the ovaries and the pathologist looks at them, whether she going to put them back into the mother’s body. Will she be able to clean them up and then reattach them? The doctor was able to explain that the ovaries are very diseased, and have been destroyed or eaten up by the cancer, so there is nothing left to put back. But she assured the patient that beyond the ovaries, they would only take away what was badly diseased, and work with the pathologist during the surgery to decide what could be left and what removed. And reminded them that this may include some bladder and bowel, and showed these items on her drawing again.
It is useful and healthy for patients to get their questions answered where they are at. It is useful and healthy for care providers to have a better sense of their patients’ background knowledge, concerns and worries. Questions, even the kinds of questions we tend to cringe at (like will anyone see my wife’s private parts) need to be answered. Because healthcare providers do not get to decide what is important to the patients and their families. I saw the doctor’s facial expression change from hurried to surprised. Then she stepped back to explain the procedure better, and talk with the patient where she is at. With each well-answered question, the faces around me relaxed and shoulders dropped. They nodded at each other.
At the end, the doctor placed her hand on the patient’s arm, and invited her to ask anything else. The patient admitted she was “too scared” to ask anything else, and just wished it was over. The doctor nodded and thanked her for sharing that. Then she added that the patient is in good hands. She is with experts at a specialty hospital. Her cancer is being diagnosed, and they are going to take out the least amount of tissue possible. Then she can meet with the cancer team and see what else can be done. “One step at a time,” she told the patient. “We will just take one step at a time!”
“We place our trust in God and in you, Doctor!” the patient responded, and her family members nodded in unison with newly earned trust for the healthcare team and the process this patient was facing. Time spent? Probably a total of ten minutes to smooth this patient’s whole cancer journey and create a space for the healing we all hope for. Time well spent for all concerned. Including the doctor, whose life is enriched by getting to know her patients more fully.
These kinds of question and answer sessions bring us much closer to our goal of fully informed consent. They give reassurance. And they help doctors communicate in a way that is more helpful and meaningful for their patients. The more we can move away from our canned presentations into a more fluid and welcoming communication style, the better patients will feel. Because what patients face on the physical front is enough without adding any unnecessary fear and uncertainty. Where we can inform and comfort, we should. I am happy to see this happening more.