The magic of a healthy doctor-patient relationship

The relationship between doctors and their patients has received philosophical and spiritual attention since the time of Hippocrates and still remains a keystone of care. But, unfortunately over the years, this special relationship has undergone a drastic transition. The onus for this actually lies on both the parties. On one hand, increasing number of litigations and the irrational use of social media has made the doctor fraternity more cautious while on the other, many patients claim that doctors treat them as consumers and the healing touch and warmth has gone.

Bobby Fischer once said “Nothing is so healing as the human touch”. As a doctor, it’s very important to counsel & interact with patients, so that their fears regarding the disease can be alleviated.

As a cancer surgeon, I feel that a healing touch is as important as a good surgical hand. Every doctor should make a sincere effort to strike a healthy relationship with their patients.

May the force be with you!!

 

 

 

(This was a card I recently received from one of may patient’s, whom I had treated for cancer)

Changing trend of Breast Cancer incidence in India

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Breast Cancer and the age wise distribution in India

This graph depicts the changing trend in the age wise distribution of breast cancer in our country. Over the years, the incidence of breast cancer has increases dramatically and there has been a higher increase in the incidence between 30-40 years of age. This is mainly attributable to the lifestyle changes visible in the Indian society. Another major factor, which is difficult to quantify is the increase in pollution levels.
It is important we realise this change and encourage patients to take corrective measure to control the modifiable risk factors like smoking, alcohol consumption, obesity. Also increased awareness is required, so that these cancers can be detected early.

Better half of a Breast Cancer Patient

Family has a huge role to play in supporting a breast cancer patient during her treatment and the most important member is the patient’s husband. My views regarding the role of a Breast Cancer Husband were recently highlighted in Health Spectrum Magazine.

 

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As a Breast Cancer surgeon, I have seen a dramatic shift (towards good) in the family’s attitude towards Breast Cancer. In my initial years of training/ practice, I had encountered patients, who were deserted by their husbands after the diagnosis.

Nowadays, the scenario is quite different. I see husbands accompanying their wives for all their hospital visits and chemotherapy sessions. This is definitely helping patients cope with their disease in a better manner and I am hoping this trend continues in the future.

Endopredict vs Oncotype Dx for Breast Cancer

A new test, called EndoPredict, can predict the risk of a woman’s breast cancer spreading within 10 years of diagnosis more accurately than the current Oncotype Dx test. Also, research found that the results can be made available more quickly.
 
A study, published in the Journal of the National Cancer Institute, compared EndoPredict with Oncotype DX. Both tests can predict whether breast cancer will spread in women with oestrogen receptor positive, HER2 negative (ER+/HER2-) disease. This is a sub-type of breast cancer that accounts for about two-thirds of all cases.
 
The new EndoPredict test analyses eight different genes found in a sample of a patient’s tumour. This information, as well as the size of the patient’s tumour and their nodal status – whether the cancer has spread from the breast to their lymph nodes – are then used to determine the patient’s risk of their breast cancer spreading in the next 10 years.
 
An ‘EPclin’ score categorises patients into low- and high-risk groups. Patients placed in the high-risk group would be recommended to have chemotherapy, but those in the low-risk group could be spared this treatment – and the debilitating side effects associated with it.
 
In the study it was found that EndoPredict was more accurate and the results were available faster as compared to the conventional Oncotype Dx test.
 
Points to remember:
1. EndoPredict is meant for early breast cancers which are ER, PR positive (same as Oncotype Dx)
2. It analyses 8 genes as compared to 21 in Onctoype Dx

5 Ways To Step Up Your Patient Interaction

Communication between a patient and a doctor is a key factor in determining the course, duration and outcome of a medical treatment. When a patient approaches a doctor for help, it immediately places the physician in a position of power. Patients are supposed to open up with their most intimate details and shed their inhibitions for the physical examination. While this position of power and complete surrender of patient helps a lot of times in diagnosing the diseases and comprehensive examination, it also leaves the patient feeling exposed with a developed mistrust for the doctor.

When the doctor patient interaction is only one sided with the patient asking the questions and the doctor answering them, it leads to miscommunications and substandard treatment with unwanted outcomes.

Take for example MDR TB. On talking to doctors in government hospitals it was found out that due to insufficient time patients were not counselled properly. This led to an increase in defaulters who wouldn’t complete their course of medication. This has ultimately led to an epidemic of sorts of MDR TB.

So how can we improve patient interaction? Read through to find out.

  1. Listening rather than asking:
    A patient comes with a lot of apprehensions and more often than not they have a lot to tell the doctor about their problems. This leads to doctor dismissing a lot of these as unnecessary talks. A streamlined approach towards a problem is undoubtedly required but a patient is not a problem to be solved. Listen to them instead of cutting them off mid way.
  2. Addressing patient query rather than dismissing them off as trivial:
    Patients come to you for help and have a lot of doubts. Let them ask their questions and be content. Disregarding their questions would make them feel inferior and you might shut them up from asking any more questions in the future.
  3. Giving ample time:
    Give time to the patient you are examining. Yes there is rush and you are busy, but the patients are exposing their vulnerabilities to you. Let them feel wanted and not just another problem on your conveyor of patients.
  4. Dress to impress not intimidate:
    Dress according to the patient population you are catering to. If working in a modest neighbourhood, dressing up demurely would help to build confidence. Also it’s time to ask ourselves if the white coat is enhancing doctor patient interaction or intimidating it.
  5. Use simplified language:
    Chuck the jargon of medical science in front of patient. Don’t use scientific terms, patients are more comfortable with laymen language. They have a red patch not erythema, swelling and not oedema. The big words make the patients feel like they are on their deathbed. Please don’t tell a patient he has pharyngitis, just say it’s common cold. And of course don’t forget the Smile Language!

This article is written by Dr Prerna Motwani. You can read more such articles here.

Role of a Breast Cancer Husband

Western statistics reveal that nearly seven out of ten marriages touched by breast cancer do not survive and ultimately lead to divorce. With the incidence of breast cancer increasing in young Indian women, this problem will soon be evident here as well. In fact, during my tenure in Bangalore, I did come across a few patients who were deserted by their families after their diagnosis of Breast Cancer.

Although there is no magic formula for a couple to weather this difficult period, but some of these points can help husbands support their wives during their Breast Cancer treatment.

  1. Stand by her during the treatment & tell her that you ‘love’ her

In a marriage or any intimate relationship, silence is not golden. The strong silent type need not apply for the position of husband, lover, best friend, confidante and supporter of a woman with breast cancer. Your bride, your wife, needs and wants to hear from you. Actions may speak louder than words, and you may take all the right actions, but speaking words brings comfort, reassurance and knowledge of your inner feelings. She cannot read your mind. Being there for her is more than physical or economic security. Words have meaning. And the three most important words in the English language at this time, at this moment, when together you are facing her mortality, are: “I love you.”

  1. Involve her in the decision making

It is not easy for a lady to deal with the diagnosis of breast cancer. Often it has been seen in India that husbands and family members make clinical and personal decisions on their behalf. Although these ladies appreciate some of the decisions but they would love to be part of others, which involve their future.

A simple example is deciding between a mastectomy & breast conservation surgery. Family members err towards the side of mastectomy but in reality a lot of young patients actually want breast conservation surgery. It always helps to consult them in private and then take a collective decision.

  1. Go to Her Appointments

It is not what you do when you accompany her to treatment, but rather the act itself that speaks volumes to her. It also gives you some sense of empowerment. You are more than a helpless spectator cursing the damned disease. You have joined the battle.

  1. Sometimes humor helps

Funny, it does. There’s even a study to prove it, by psychologist Sharon Manne of the Fox Chase Cancer Center in Philadelphia. Couples who laughed at cancer coped better with the stress of treatment. We know that the act of laughing is itself healing. It makes us feel better and helps us get better.

  1. Continue to enjoy as a couple – she is NOT invalid

Treatment can be grueling and tiring, but you both need to live your life as fully as possible. Continue to enjoy what you enjoy individually and as a couple, particularly the latter. Don’t let cancer put an end to your personal and social life.

 

If you follow these simple steps, you can also become a Proud Husband of a Breast Cancer Survivor

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Article By:

Dr. Rohan Khandelwal

Consultant, Breast Oncosurgeon

W Pratiksha Hospital