An Illusion of Caring

In 2002, around the time that the Writing is Good Medicine® program was launched at the cancer center in Bennington, the Center for Communication in Medicine was also offering the Doctors Conversation Hour to hospital physicians. This monthly meeting offered a forum for frank discussions about the challenges of practicing medicine. So, I began to wonder whether expressive writing exercises could also be of benefit to doctors in exploring professional and personal challenges as it had been to cancer patients in revealing issues and concerns in facing illness.

I can’t recall whether I was invited or I invited myself to the hospital’s Tumor Board. This weekly conference included doctors from various specialties that gathered to present cases and seek input from colleagues regarding diagnoses and treatment planning. On one occasion, after spending time reviewing scans, biopsies and reports, the pathologist, oncologist and surgeon agreed on a cancer diagnosis with a poor prognosis. The surgeon was tasked with sharing the findings with the patient and her husband but openly admitted that he was searching to find the right words to say. I was often struck by the difficulty that doctors had in breaking bad news, which I assumed they would have learned during their years of training. After a while, the doctors who attended Tumor Board became familiar with my role as medical humanist in documenting the patient’s perspective of illness for the cancer care team. At times, when they struggled with finding the right words for delivering bad news, they would turn to me, a writer. Essentially, there were asking for a script, which the surgeon did that day.

This struggle to find the right words for difficult conversations gave me an idea for a Doctors Conversation Hour topic. I emailed the participants and asked them to write about their experience of communicating bad news. Like with the patient’s writing group I instructed them to start with the first thought that came to mind and follow it without thinking about grammar.

One of the doctors wrote, “Some patients seem to have unrealistic expectations but a real need to know that someone cares about them and their problems. In a way, they may be asking that a doctor create the illusion that he/she cares. Although this concept has an element of comic relief, the effort and time a doctor spends listening to a patient and creating a sense that the patient has been adequately cared for develops a win-win situation for both the doctor and patient.”

The doctor went on to say, “The initial idea of giving this patient a quick fix for a perceived non-fixable problem seems to make it easier to approach a difficult patient without the overwhelming feeling that you may not be able to help the patient.”

These words prompted a candid discussion about the pressure they sometimes feel in meeting patients’ expectations of being a “caring doctor.” It reminded me that doctors have a hard job. They may not always allow themselves to feel the suffering of each patient but truly have a desire to show that they care, even if they need to ask for the right words. At the next Tumor Board, the surgeon reported that he used my script. And, although the patient and her husband were devastated in hearing about the seriousness of her medical condition, they expressed appreciation for his kindness and support. The surgeon also admitted that the outcome of this difficult conversation was a relief to him.

So, I’d like to pose this question. How would you feel if you had the impression that your doctor was creating an illusion of caring rather than expressing heartfelt empathy?