Sunday, January 27, 2008
(Here's another of the posts I wrote a while back, and didn't publish, in my "why bother" phase.)
Once again (it seems this keeps being reported, about annually) we have a report which states that doctors (especially surgeons) are doing a poor job of informing women about reconstruction options after mastectomy. I'm at a loss; I simply don't know what to make of it. My mind is filled with conflicting thoughts.
The first thing that comes to mind is a question: is it true? And: if so, how can it be? And: if it's not true, what's up with the report? And the ones before it. And before those.
I've written about what a complicated and difficult mission it is properly to explain breast cancer treatment to patients. And it's not just because the subject is complicated, with many components to treatment and options within those components; it's also that such a discussion takes place in the context of a mind near to or beyond blowing, enwrapped and nearly erased by fear and shock. There's only so much that can be absorbed.
There are two corollaries: one is that there's a tendency to compress the info, especially during the first encounter. The other is that -- and I know it well, having witnessed it time and again -- even the most careful discussions can be misunderstood, partially forgotten, or misconstrued in the horror chamber that is that initial consultation. Which is why I wrote a booklet recapitulating the information I shared, and personally handed it to each of my breast cancer patients. Even then -- and this really bugged me, because I prided myself in my commitment and ability to explain things to my patients -- I'd get the rare call from a pre-op nurse saying my patient hadn't signed the permit because she said I never explained things to her.
So what I'm saying is this: before swallowing the data without chewing, I'd think there's some number of people who actually did get informed but who zoned it out. Far be it from me to defend surgeons. I know the category includes many who are jerks, who can't be bothered to do much more than cut and run. But to the extent that the data are true -- and I question it -- it may not be entirely layable at the feet of the cutters. And it may also be the case that some surgeons practice in an environment where most of the counseling and decision-making is done with primary docs or oncologists, wherein the patient shows up at the surgeon's door with mind already made up. Or polluted. I absolutely rejected that style; in fact, I agitated to get involved as early as possible. But other approaches are not always unreasonable.
Without doubt surgeons could, as a group, do a much better job of talking to patients. But when someone says he or she was never told this or that, it ain't necessarily so. And when it is, shame on us.