Dear Sherri: Why Does My Oncologist Always Ask Me How I Am Feeling? Shouldn’t He Know?!

Sherri blogs at sherrifillipo.com

We had some additional question for Sherri Fillipo.  Sherri is a former nurse who has been living with metastatic breast cancer since 2012. Sherri spent more than 25 years as a nurse–first in the operating room and then as a patient safety and process improvement specialist. Sherri previously contributed “Improving Your Cancer Experience” and “Both Sides Now: What Happens When a Nurse Becomes a Patient.”

–Katherine O’Brien, Secretary, MBCN

 

One oncologist says he always asks patients “How are you feeling?” and many respond “Well, Doc, you tell me.” He says he really wants to know….because tests only tell him so much–he needs to hear from the patient. Still, I hate to complain. Any advice?

If a physician asks, tell him/her. Yes, your chart has been reviewed and your vitals have been noted but he/she wants to hear from you how you are feeling. Objective data tell a care provider only so much. What you often start out with is what is on your mind. Your nurse or your physician can then delve deeper and get to the heart of the matter. Paper and computers don’t give the full picture.

On several occasions my oncologist has referred me to other doctors at the same institution. For example, after a thyroid nodule was seen on scans, I was sent to a specialist. All of these specialists start out with “Why are you here?” What’s up with that?

As odd as it sounds, sometimes physicians and nurses will ask a seemingly obvious question to a patient to ascertain the level of understanding the patient has for the topic at hand. Over the years I have learned a huge amount by asking and then listening to a patient’s response.

I remember years ago while preparing a patient for surgery, he had been asked about his NPO status (nothing by mouth after midnight) which is a crucial question to have answered prior to anesthesia induction. We don’t want any patient with a full stomach coming to surgery and then being sick. It can lead to all kinds of trouble. Anesthesia asked this gentleman if he had eaten or had anything to drink since midnight and his answer was no. A colleague of mine who worked in the pre-op area asked later and indeed the answer was no. As I was going through my list of questions, I asked a third time. This was his response, “Well, I had a biscuit and a cup of coffee because I knew it was going to be a long day.” Case cancelled!

I have decided to get a second opinion but I feel like I am insulting my doctor. Help!

If you don’t feel comfortable with the information you have been given for any reason, you have every right to seek a second opinion. Physicians are used to patients doing that. The only potential challenge might be if you had two very divergent care plans. Then you would have to decide what to do.

This is a good time to remind people about the patient bill of rights–typically a framed document you might have seen posted at entrance points in your hospital or infusion center like Admitting or Registration.  Below is a sample of the one at the hospital where I work per diem. It is actually much longer but gives you an idea of what it looks like.  Note the last item I listed:

• You have the right to respectful care given by competent personnel and also, reasonable access to care in a manner that is timely and that minimizes discomfort.
• You have the right to expect emergency procedures to be implemented without unnecessary delay.
• You have the right to considerate and respectful care with consideration of your psychosocial, spiritual, and cultural values that may influence our perceptions of illness and care. You have the right to good quality care and high professional standards that are continually maintained and reviewed.
• You have the right to request care as long as care is deemed medically necessary, and to participate in the development and implementation of your plan of care.
• You have the right to be well informed in layman’s terms about your illness, possible treatments and likely outcomes including unexpected outcomes, and to discuss this information with your doctor so that you may make an informed decision.
• You have the right to know the names and roles of people treating you.
• You have the right to consent or refuse medical care or treatment, as permitted by law, and to be informed of the medical consequences of such refusal.  If you refuse a recommended treatment, you will receive other needed and available care. You have the right, except for emergencies, for the physician to obtain necessary informed consent prior to the start of any procedure or treatment or both.
• You have the right to assistance in obtaining consultation with another physician at your request and expense.

 

Should I provide a new physician with a quick oral history?

If the physician sits down and gives you a quick oral history of your condition, you can bet he has reviewed information that was provided to him/her by your attending physician. He may ask you to give a summary to compare with what he already knows. If you find that you need or want to provide one, again I am a big believer in carrying that small notebook with you so you can have your thoughts arranged logically. In preparing for your appointment, you might use this template:

1. Diagnosis
2. Date of diagnosis
3. Current meds
4. Surgeries? What done? When?
5. Reason for your visit today
6. What you hope to gain by seeing this specialist
7. Anything pertinent to the visit

Surgery is not standard of care for metastatic breast cancer, but my doctor thought it was worth considering. He sent me to a surgeon–the surgeon was arrogant and basically stressed my Stage IV status. What a waste! Couldn’t my doctor have spoken with the surgeon prior to my appointment?

Yes, they should have had a conversation prior to your visit. When a physician wants a patient to see another physician, this is called making a consult. It can be done via the computer or through a phone call. A brief outline of the need for the consult and the expected outcome of the meeting should be noted and understood by all.

Now to the surgeon part. I am sorry for the arrogance displayed by the surgeon. And in by no means am I defending him/her. (Remember I spent many years in the surgical arena. I have seen and heard it all.) If the surgeon was an oncological surgeon, I would expect a completely different response than if he/she was not.

Although respect should be the foundation of all patient-physician relationships, I wonder if this surgeon was out of his/her comfort zone and was at a loss for what to do or say. It doesn’t make it right but it makes me wonder. Remember from the last Q&A I did, if you want the complaint to be dealt with, use your resources in the hospital such as the Patient Advocate or the manager of the department. Let him or her know your experience with this surgeon. Trust me. Hospitals want to provide compassionate care and if you feel you did not receive it during this surgical consult, administration wants to know.

 

 Do you have a question? A suggestion for a future Q&A? Please comment below.