The primary focus of my role as a medical humanist has been to help patients prepare to open conversations with healthcare providers about their health status and planning of care. I can recall instances when I was working at the cancer center in Bennington when patients would ask their oncologist about uncomfortable topics such as prognosis and expected survival time. I observed that even for doctors the truth can be hard to talk about.
In the Difficult Conversations video, Laura tells us, “Doctors have a hard job. Not everyone wants to have these conversations, some people do.” Her comment brings to mind how doctors may not be able to gauge when a patient is ready to hear bad news. What can make it more challenging are time restrictions at office appointments, which can present a barrier to discussing emotionally laden issues surrounding options when treatments have failed. So, you can see how uncomfortable topics could be side-stepped.
I believe it’s important that doctors and patients acknowledge to one another that there can be a tendency to avoid topics that are hard to talk about. This has been described in the medical literature as a “collusion of silence.” Yet, a shared willingness to discuss failed treatments and prognosis can open a door to timely conversations about risks and benefits of options in planning of care.
With a need to help bridge this communication gap, I created SpeakSooner: A Patient’s Guide to Difficult Conversations, which is designed to activate patients to identify and express their questions and concerns. For example, the format of the chapter on prognosis prompts patients to inquire about the distinction between curable and treatable. Although taking the initiative to open difficult conversations is not easy, patients can remove “mind reading” from the interaction and encourage doctors to offer truthful medical information. As you can see, the SpeakSooner communication model I’m describing does not reflect the conventional doctor-patient power dynamic. That’s because patients must ensure for themselves that they have an understanding of their health status, options and have a say in planning of care. It doesn’t serve either doctors or patients to have avoidance as a default position.