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Ronny Allan
Reviewed and updated 4th June 2022
Patient doctor communications
One of the most frequent posts on patient groups and forums is about the Patient-Doctor relationship (or occasionally a lack of it…..). Personally, I have a lot of time and respect for all medical staff and I suspect that has been influenced by my general life experience, perhaps cemented since my diagnosis of metastatic Neuroendocrine Cancer in 2010. The vast majority of people tend to trust Doctors and I’m a bit old-fashioned in this respect. If you have metastatic Neuroendocrine Cancer, you see medical staff a lot! Relationships and communication can therefore become more important than ever.
However, people with less common conditions can perhaps be more difficult to satisfy. A ‘generalist’ doctor (i.e. a GP or PCP) is unlikely to be very knowledgeable about every single condition. Even at the secondary care level, many less common conditions still need dedicated specialists, and these services may not be located at every hospital. Clearly, with Neuroendocrine Cancer, the optimum scenario is to be treated at a NET specialist centre or at least be overseen by them. However, these can be thin on the ground, and/or the medical system in place is not able to provide access to these experts. Geography may also be playing a part in causing further anxiety and this is not helpful if you are already fighting cancer. Communications and relationships between patients and doctors can therefore be more difficult even with the right diagnosis.
I see so many issues on forums ranging from people who are simply looking for a specialist to people who still don’t think they got the right treatment from the specialist they eventually found. I’ve seen emotions directed at physicians ranging from ‘god-like adulation’ to being fired! If you only looked at forums, you would believe there are only a handful of Neuroendocrine Cancer specialists, when in fact there are many. Check out the most up-to-date lists inside this article – click here.
I know from talking to other patients that some have not had the ideal experience with their doctor(s). Even those who found a NET specialist report the odd issue and feelings of unhappiness. I never cite these issues publicly, in particular the hospital or the doctor, because for every one of these stories, you can find dozens of good patient experiences with the same hospital and doctor. I also banned direct naming and shaming in my own private support group for that very purpose.
It’s a really complex area and it can be compounded by the health system in place, but many things are common across the board. One of the reasons making it complex is that it can be about relationships and communication – both ways! Thus why I was interested to read an article by a physician who listed a number of tips for patients which I think are as relevant to Neuroendocrine Cancer as they are to other conditions (……in fact some more so!). Relationships and communication will not cure or reduce your cancer; or debulk your tumours – well not directly ….. but it can help along the way. And although the article appears to be written in a post-diagnosis context, some of it is also relevant to pre-diagnosis.
I’m often shocked to hear that people ‘fire’ their doctor, but I guess if you are paying out of your own pocket, it can be an apt word to use! Clearly, if the service you receive is not working to your expectations, then a move might be beneficial for both parties. It’s a big decision though and for those who have moved on, I sincerely hope the grass has been greener on the other side. I very much suspect it wasn’t for some who made the jump over the fence.
The original article can no longer be found on the internet, fortunately, I had already captured the 8 tip headings below adding my own commentary.
The top 8 tips for patients from a physician with my own commentary are:
- Know your own communication style and preference for informing and being informed. This is an interesting point which I hadn’t really thought about. That said, some of the response to this tip can be addressed in some of the other tips. I guess in hindsight, asking my doctors not to hide stuff and to just “hit me with it” is an indication that I had set my preferences early on. I wanted to know the real problems I was facing. Additionally, my Oncologist knows I like copies of all tests and reports, and he obliges. I always take notes.
- Think about how you prefer to hear important health information such as the results of a biopsy or a scan and then convey that to your doctor or nurse. I think this is partly addressed above. I see my MDT face to face every 6 (recently 12 months) but if it is for bad news, I would certainly like some notice in order that I can be accompanied by my wife. I don’t think I’ve made that clear enough so an action for me here. That said, I see my scans before my appointments and that is most likely the source of any bad news.
- Prioritize your concerns, if you present your doctor with a very long list of questions or symptoms at the very end of the visit, it’s quite likely that you will both end up frustrated. I have experienced this issue many times but gradually I’ve learned how to improve this form of communication. It’s easy to forget your physician has other patients and only has a finite time to spend on your case. In the early days I would send my Oncologist a summary email with my top 3 or 4 concerns around 2 weeks prior to each appointment. I copy in the specialist nurse who is mostly already aware via frequent communications. This not only gives them some time to read but also prevents the scenario above. It’s starting to work better. After 10 years of appointments, this is much easier and I tend to deal more with my specialist nurse.
- Make your needs known, doctors and nurses cannot read your mind. This is an absolutely key tip as far as I’m concerned. I believe the patient is the most underused person in healthcare. Patients even have a part to play in their own diagnosis phase and this continues all the way through to ongoing treatment. Patients must have a voice and patients must use this voice to describe what’s going wrong with their body and what’s troubling their mind. Doctors and nurses cannot read your mind but they can (and must) listen to your voice.
- Trust the clinicians involved in your care and think of them as partners. I think all clinicians want us to trust them after all they’ve done the 10 years training and we have not! However, with less than common conditions, I suspect patients probably need to be wary and advocate more. I think of myself as a partner (part of the MDT for the period of my consultation) and so by default, I already think this way.
- Beware of the common trap of thinking in terms of all or nothing or rushing to conclusions. This is an interesting one for incurable but treatable cancers. I think with incurable Neuroendocrine Cancer, you need to be prepared for a long haul and the occasional bump along the windy road. Services and inspections will need to be done and tyres will need to be changed. It’s not a perfect journey and don’t trust the SatNav!
- Share the burden of not knowing how things will ultimately work out. This is a difficult one and I suspect each person will have their own concerns and their own way of dealing with it. I’m thinking this might be even more important for younger patients who have young families to look after. I’m a ‘glass half full’ person so it’s an awkward one for me. I guess as I’m feeling confident I’m not leaving anytime soon, it’s something still stuck in the back of my mind.
- Find ways of being at ease, even during frightening or turbulent situations. Easier said than done! Again, we all have different ways of dealing with our situations, but I do believe if you have addressed all the tips above, this should make it easier. I also think that learning a lot more about your disease really helps to communicate about it better.
You may enjoy my article – Diagnosed with Neuroendocrine Cancer? – 10 Questions to ask your Doctor
And this one – 8 tips for conquering fear. 
Disclaimer
I am not a doctor or any form of medical professional, practitioner or counsellor. None of the information on my website, or linked to my website(s), or conveyed by me on any social media or presentation, should be interpreted as medical advice given or advised by me.
Neither should any post or comment made by a follower or member of my private group be assumed to be medical advice, even if that person is a healthcare professional.
Please also note that mention of a clinical service, trial/study or therapy does not constitute an endorsement of that service, trial/study or therapy by Ronny Allan, the information is provided for education and awareness purposes and/or related to Ronny Allan’s own patient experience. This element of the disclaimer includes any complementary medicine, non-prescription over the counter drugs and supplements such as vitamins and minerals.
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A hearty AMEN to number 4! The lack of which often is the stimuli behind the word fired being brought into the doctor/patient relationship.
In the States, doctors and patients are “fired”. We are paying for a service. Doctors are fired in the same manner a mechanic or plumber or any other professional hired by an individual would be. Sometimes this means we can get better care than in managed care.
Doctors fire patients mostly for noncompliance with all treatment plans(this is usually extreme noncompliance such as drug abuse or self negligect). Patient are also released from service for missing appointments. The doctor cannot maintain a solvent practice if appointment slots aren’t used as billable time.
In UK, we just ask for another doctor 🙂 but I think it’s less of an issue – we have much stiffer lips than other nations 🙂 That said, I guess it’s similar to ‘firing’…. NHS is not really free as technically they are paid by taxpayers (patients ….)
Excellent tips, Ronny! I would add a piece of advice that I was given at the time of diagnosis. Get a notebook and keep track of everything! Mine has a section for consultations where I write notes about who I saw, why and what the outcome was; another for tests, procedures and treatments so that I can easily give dates and details when asked; and another for Sandostatin where I keep track of each injection (when, where, by whom, blood pressure, etc). It has pockets where I keep all sorts of things including lists of previous surgeries and the medications I’m presently taking, my personal directive, patient information pamphlets and so on. The notebook also contains the phone numbers and other contact information for all those involved in my care and I use it to jot down questions that I want to ask at upcoming appointments. It has been a lifesaver and my primary NET doctor has commented more than once that he wishes all his patients were are organized.
Great point, I might add that 😆
Very well written Ronnie. Great advice also. As a nurse and patient with carcinoid lung cancer, I can only say that all eight things you mentioned are so helpful in approaching this disease with an organized, academic mindset. With a physician husband, all you have said about their time constraints are true also but preparing for your visit as you mentioned and being a vital partner in your care is crucial. Thank you for the wonderful insight. Glad you are there to help so many readers. I know our care in the US is a bit different but still with the same challenges.
I was amazed at what a difference having access to a specialist centre can make, and some good advice there too😃
yes, I think we’re quite lucky in the UK although some areas have sparse coverage. I really feel for the people who don’t have the right access to treatment and specialists who know when and how to administer it.
We take a lot for granted, the NHS is a wonderful thing, and we are very lucky.
Reblogged this on Tony Reynolds Blog and commented:
What’s Up Doc…..we got a communication problem??
Ha Ha, I changed the title about 3 times during drafting. What’s up Doc was one of them 😁
Hi Ronnie, hope you’re feeling well
I see an NHS and private consultants and now am in talks with Heidelberg hospital to have possible surgery. I was interested to read you attend the MDT meetings? I didn’t know this was an option. It would be interesting to attend as I appreciate in clinic, like you say, my consultant doesn’t have time to answer every single question, therefore attending an MDT meeting would be beneficial to both
Because I’ve been stable for some time, I tend to have a one to one with the Onco and then one with the NET specialist Nurse. The full MDT seems to be for those just diagnosed and in their initial treatment. Not all areas do this but I have heard of a few in UK. Good luck!