Common courtesy can humanize cancer care

The modern medical system is built on a one-on-one relationship between patient and physician. (AP Photo/Jeff Barnard, File)

Every major disease now has its month. Prostate cancer is exceptional, though, in having three. There’s Prostate Cancer Awareness month in September, while the Movember Foundation has claimed November as the month to raise awareness about the same disease. And every June there is an array of prostate cancer campaigns — Walks for Dad, Rides for Dad, Do it for Dad, Wear Plaid for Dad — all linked to Father’s Day, just past.

As both a prostate cancer researcher and survivor, I honour all events that aim to improve the lives of cancer patients. But no matter how many days are delegated to raise cancer awareness, cancer care remains an emotionally painful experience. From both the patient and research perspective, cancer care is too impersonal, industrial and needlessly stressful.

It doesn’t have to be that way. But before delving into solutions, let’s first define the problem.

The modern medical system is built upon a personal one-on-one relationship between patient and physician. The patient has a primary care practice physician, a PCP, who attends to routine medical matters. If the patient needs specialist care, the PCP makes a referral, and the specialist then treats the patient and refers the patient back to the PCP.

At least that’s how it works in theory, and how it may have worked decades ago. But as health care has improved, it has also become increasingly complex and labour-intensive. The one-on-one relationship has been lost when a referral to a specialist sends the patient off to not one, but an army of new health-care providers.

Complex system adds to stress

Many patients who are referred to specialists, myself included, have found the complexity of the medical system overwhelmingly unfriendly. Many patients are relieved when referred back to their PCPs. Still others transfer their trust to their specialists, feel safer when treated by them, and dread being discharged back to their PCP.

A nurse inserts an IV for chemotherapy at the Fox Chase Cancer Center in Philadelphia. (AP Photo/Matt Rourke)

If the patient’s disease requires continual treatment and monitoring, patients can become increasingly anxious about who to contact if new concerns arise. They want to know and trust their doctor, and be able turn to him or her whenever necessary, whether that’s their specialist or their PCP.

Problems arise, though, when a lot of people are involved in providing health care, such as in the oncological setting. All health-care providers can justifiably affirm that the patient in their care at any moment has their full attention. So the focus on the patient is not the problem. Indeed, from the patient’s perspective, the issue is not who is - or isn’t - focusing on them. Rather it’s the reverse; who should they be looking to as their key health-care provider at any one moment? Who should they trust most to have the information and skill set that will assure them the best care possible? Who can they, or should they, trust right now?

As a psychosocial researcher, I am interested in diminishing the uncertainty and insecurities that mount for cancer patients as they access more health care. The uncertainty about who to trust at any moment erodes patients’ confidence in the entire medical system. The problem grows both when patients are referred to a cancer centre for diagnoses and treatment, and when they are referred back to their PCP for follow-up care. We must reduce patients’ uncertainty about which health-care provider they’re supposed to talk to about any given problem that emerges along the cancer continuum.

Building trust

I propose a simple way to reduce stress on patients as they navigate cancer care by building patients’ trust in the system overall, because bolstering patient trust in their health-care providers does more than simply improve patients’ peace of mind. Several studies have shown patient trust improves health outcomes overall.

An act of common courtesy is key to my proposal. Trust in one doctor can be transferred to another if a patient can personally witness the trust both doctors have in one another. And that can be achieved by a simple personal introduction.

My “transfer of trust” proposal could apply to all health-care situations in which a patient is referred back and forth between a specialist and a PCP. It’s built upon personal introductions of patients by one physician to another. Such introductions are a common human activity that are nonetheless rare in the modern medical setting. Instead, we have referral letters, scripted care plans and phone calls made on behalf of patients. Rarely are patients part of, or even present during, the transitioning process that moves them from one physician to another at the critical periods when insecurity and anxiety about their welfare are high.

Personal introductions can be incredibly reassuring for cancer patients parachuted into a large and complex health-care system. They can help patients overcome the anxiety they feel when circumstances force them to place their survival into the hands of the strangers to whom they’ve been referred.

Such simple, brief introductions would give physicians a chance to show to patients the respect they have for each other, attesting to and demonstrating their trust in one another. When words are heard, not just read, and facial expressions are visible trust and respect are demonstrable.

Phone calls better than no personal interaction

If it’s difficult for both specialists and PCPs to be in close proximity to the patient for an in-person introduction, modern videoconferencing can solve the problem. Skype, FaceTime or Webex on a cellphone can make such introductions quick and practical. Even a simple conference call works, if video isn’t possible. It might not be ideal, but it’s still a personal touch and thus can help reassure a patient that the physicians are on the same team working on his or her behalf.

The calls or introductions would allow patients a chance to personally make the acquaintance of the next physician they are scheduled to see, and would enable the patient to ask both physicians about who they should contact first if problems arise. The meetings would have a time limit and a pay rate that would be the same for both physicians. They’d be short, given their sole purpose is a personal introduction, and it would be understood by both patients and doctors that the introductions are not meant to be full medical co-consults.

Such “transfer of trust” calls would enhance patients’ confidence that the physicians are part of an integrated health-care system and working collaboratively to ease their anxiety. Done right, these calls should also save the physicians from unnecessary duplication of patient calls and office consults.

And in the long run, both patients and health-care providers will benefit from the trust engendered by this simple, humane addition to medical care.