How to Communicate as a Healthcare Provider: 3 Patients Weigh In
For those who have received a diagnosis of cancer, or were present when someone else has, the memory of that moment sticks in strangely specific ways. We might recall the color of the wallpaper or the music on the radio, what we’d eaten that morning, or the smell of the hand sanitizer. And it’s common for the overwhelm of emotions in that moment to make it difficult to retain important information such as the specifics of the prognosis and plan. Rather, we remember the way our medical providers communicated the life-changing news. We remember their tone and their gestures. We remember how kind they were or how unkind. In that moment of panic and uncertainty, we hope to be presented with clarity, compassion, and confidence. Not dismissal or a sense of hopelessness.
“My mother-in-law had back surgery when she was sixty,” says Sandra Deering, a Nurse Practitioner from Michigan. “At the 6-week post-op check we were sitting in the crowded waiting room and when the surgeon came out, she told him, “Gosh, Doc, I’m still in a lotta pain,” and before she could even finish her sentence, he said, “Stop. You got worse problems. You got breast cancer. And it’s not survivable.” I remember being totally shocked and asking if we could go speak somewhere privately.” Sandra’s mother-in-law had metastasis in her spine, and the pathology from surgery had revealed the cancer cells were from the breast. Obviously, this was a devastating news, made more traumatic by learning that she had Stage IV Breast Cancer in the waiting room. Sandra says, “It’s the first time in my life I thought my calm and kind husband was going to punch someone. He didn’t.”
Unfortunately, many women have similar stories of hearing harsh and insensitive words in moments they most need tenderness and guidance from their providers. At age thirty-three, Tracy Thorndike, now an Associate Professor in Washington, was navigating a metastatic breast cancer diagnosis when she was flippantly told by a Medical Oncologist, “Obviously you’re done having children.” With just one toddler at the time, Tracy hadn’t been at all sure she was done having kids. There was nothing obvious about this to her, and this callous assumption from the oncologist added to her sense that the cancer was taking away her power and controlling every aspect of her life. While it is true that chemotherapy and hormone suppressing therapies for breast cancer treatment do impact the ovaries (it’s common to experience menopause-like symptoms, at least for the duration of treatment), there are ways to preserve ovarian function and to take steps to ensure the possibility of future children. This was always going to be a complex, difficult conversation, but had the oncologist laid out the obstacles and the options in a more considerate way, the realities of treatment could have felt less jarring and absolute.
Thankfully, Tracy had a wonderful breast surgeon who was “the only one who made things bearable at my initial diagnosis.” When discussing the pathology report and prognosis, the surgeon said, “This is bad but we’re going to fix it;” words that Tracy clung to over the hard months of treatment that followed. They were, “Truthful but hopeful. Hope is key.”
Dr. Amy Heeringa, OBGYN in Michigan, was diagnosed with breast cancer at age thirty-six and had a breast surgeon who offered her both honesty and hope. She said, “This will be the hardest year of your life, and then it will be behind you.” Amy found this hopeful, honest, and mostly accurate. “It’s true. The first year is rough, but it’s never really behind you. You are new and different, you learn to live with cancer as part of your story. Some days it looms closer than others.”
It makes all the difference to have at least one go-to point person who understands what we’re up against and walks with us through it. This might be the breast surgeon, or in some larger cancer centers, it person might be a nurse navigator or mid-level providers (Nurse Practitioners or Physician Assistants). Their job is to make sure we understand the medical jargon, the specifics of our diagnosis and all elements of testing and treatment, as well as coordinating with the care team, which often includes interventional radiology (for mammograms, MRI’s, image-guided biopsies or tracer placement), radiation oncology (for radiation therapy), pathology (for interpreting the results of the biopsies), medical oncology (for chemotherapy), breast surgery (for breast tissue removal; lumpectomy or mastectomy), and perhaps physical therapy and plastic surgery.
Finding the right care team is critical. Hopefully, as more patient-centered education is offered to medical students, we can expect more honest and hopeful versions of these difficult discussions from our providers. Medical providers have a responsibility to communicate clearly and carefully, as their words will echo long after they’re spoken.
For those of us who are walking alongside our friends and family experiencing cancer, being there as ally and advocate during the meetings with medical providers is very helpful. Be the note-taker or question-asker, whatever can help them get the information they need in the most dignified, least-stressful way possible. A sense of powerlessness is also common, so listening and validating their feelings is key. No matter the stage at diagnosis, there is an element of grief and loss with a cancer diagnosis, so this guide is also very helpful.
Sarah Zimmerman is a freelance writer in Northern California and is working on her first novel. In past lives,, she has been a Physician Assistant in Women's Health and the owner of a vegan ice cream business. Sarah writes about marriage, sex, parenting, infertility, pregnancy loss, social justice, and women's mental and physical health, always with honesty and humor. She has written for Ravishly, Cafe Mom, Pregnant Chicken, and more and can be found at sarahzwriter.com and on Medium, Twitter, Facebook, Instagram and TikTok at @sarahzwriter.