Prof. Jan Stöhlmacher, as an oncologist, had to give the patient a devastating diagnosis many times. However, it was only when he was talking to a doctor with his brother, who heard that he was terminally ill with cancer, that he realized that the specialist’s communication with the patient had to change radically. In an interview with Die Welt, the professor of internal medicine, hematology and internal oncology suggests how doctors should spread bad news and what patients and their loved ones can do to create a good atmosphere for conversation.
- Prof. Jan Stöhlmacher is a specialist in internal medicine, hematology and oncology. Works in Berlin
- – The doctor said goodbye to him with the words: “it will be fine”, which I found inappropriate and not very empathetic – recalls the oncologist’s conversation with one of his brothers suffering from cancer
- – Inappropriate words and bad manners can ruin the doctor-patient relationship. Conversely, good communication is part of therapy, the professor believes
- More information can be found on the Onet homepage
Author: Claudia Ehrenstein / The World
The Welt: How does it feel to be a doctor at a doctor’s office?
Prof. Jan Stöhlmacher: Mindfulness on the other side is greater because the doctor knows that he is dealing with a doctor. I understand medical language and can ask precise questions. It gives me a sense of security. When it comes to anxiety and emotions, I am no different from other patients.
You accompanied your brother when you found out that he had cancer. How do you remember that moment?
My brother had sent me the results of his tests earlier, we were afraid of the worst, so the diagnosis came as no surprise to me. But she hit my brother with all her might. He refused to admit the symptoms he was experiencing and completely disavowed the fact that he might be suffering from a terminal illness. Consequently, he was completely overwhelmed by the diagnosis. I, on the other hand, was unprepared for the role of a supportive family member. I felt helpless and didn’t know how to react at first.
The rest of the text below the video.
How did you deal with this situation?
The doctor wanted to discuss the details of the therapy with my brother, but I saw that he was unable to do so. He was stunned, unable to utter a word. So I suggested ending the interview and making an appointment soon. This gave my brother some space to adapt to a new situation that completely changed his life. It was at this point that I realized how important my presence was to him. The doctor said goodbye to him with the words “it will be fine”, which I found inappropriate and not very empathetic.
What did this change of perspective from a doctor to a companion change in your perception of the situation?
My other brother was also diagnosed with cancer and I accompanied him to the doctor’s appointments as well. I have had a similar experience: talking to a specialist in certain situations can overwhelm the patient. It seemed important to me to care for patients in this aspect. Encourage them to ask questions and also interrupt the doctor if they don’t understand something. And for us doctors to realize that when a person finds out about a serious illness, it is one of the most important conversations in his life.
Why is proper communication so important?
Inappropriate words and bad manners can ruin the doctor-patient relationship. Conversely, good communication is part of therapy. A patient who trusts the doctor will join in and take medications regularly. Trust comes from honest, understanding, and patient-oriented conversation. In addition, the doctor also wants to receive honest and complete information from the patient.
How should patients prepare for a visit to the doctor?
Anyone who goes to the doctor for the first time with symptoms can write down the answers to the most important questions on a piece of paper: since when does something hurt? Where does it hurt? How is pain felt? When does he appear? What makes it worsen or diminish? It is also important for the doctor whether the ailments have already been consulted by another doctor, whether the patient has already done something with them and what the result was. The patient should report these facts without taking into account his own assumptions, which are based, for example, on internet research. These can be “carried out” later. Otherwise, it is difficult for the doctor to distinguish facts from suppositions. It is also important for patients to speak for themselves and not wait to be asked for all the details. Patients who go to the doctor’s office are often convinced that they do not have to worry about anything anymore. This is not the correct strategy. Without the patient’s cooperation, the doctor is in a losing position.
When is it worth taking a loved one with you to the doctor?
If you have the feeling that a serious diagnosis is involved, I strongly recommend that you ask someone to go with you – a relative or other trusted person. This person can comfort, but also listen and remember details that the patient will miss in their emotions. It is worth remembering that doctors want to work effectively, so they try to fit as many issues as possible into the conversation. The patient does not have to take part in it, he can say: I can’t do it. I know I have cancer. That’s enough for me today, I don’t want to hear any more.
To what extent should relatives interfere with the doctor’s conversation with the patient?
I think it is worth determining this before going to the doctor together. For example: if I cannot continue the conversation, you enter. Or: please hold back. The companion can take notes which can later be discussed together in private. If a decision needs to be made quickly, for example because therapy should begin quickly, this should be clarified in the office.
Does such a thing as confidentiality also apply to relatives?
In fact, yes. Often, however, silence is simply assumed. It is also worth talking about this in advance. A doctor’s office is by definition a safe place where confidential matters are discussed. It must be clear to the doctor that the patient wants a loved one to be present.
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How do you prepare for difficult conversations with your patients?
It sounds clichéd, but I make sure I have the relevant documents and results in front of me that I want to talk to the patient about. Then I remember how I received the patient in previous interviews: is he impulsive or rather introverted? How will he react to the diagnosis? Is it possible that he will doubt what I say? Can it break down? It helps me adjust to the situation.
What if this is the first time you see the patient?
I let him talk to find out how he thinks and what is important to him. After the first conversation, I usually can’t guess how someone will handle bad news. As an oncologist, I have to come to terms with the fact that the patient sometimes says nothing or that he cries. I also have to put up with a patient who, in an act of despair, gets up and walks frantically around the office. Of course, I can’t react to this with the same impulsiveness.
How difficult is it to find the right tone so that the patient feels taken seriously?
Both the doctor and the patient do not always manage to hit the right note. If things get out of hand, you should deal with the problem as calmly and openly as possible, and perhaps apologize. Not being taken seriously is the most common reason patients seek a different doctor.
Are doctors properly prepared to talk to patients?
In the 90s I studied in Rostock and Kiel. Back then, the doctor-patient conversation was not an important topic. Today, many universities attach greater importance to this, and medical associations often offer physicians training in communication. Unfortunately, they are not very popular. Training in communication skills is certainly more important for “oral medicine”, ie internists, neurologists and palliative medicine specialists, less for surgeons. However, everyone should have basic knowledge.
What do you do differently in communication with the patient today?
The experiences with my brothers gave me a lot to think about. They are both already dead. For me as a doctor today it is more important to pay attention to what the patient gains during the conversation and to be open and friendly to him. Even if the topic is difficult or about terminal cancer, the conversation between doctor and patient can still be good. Everyone who comes to the doctor wants to be sure. Transparency and empathy are key.