Communication is difficult during the best of encounters we humans have with each other. It is exponentially more difficult when we are under stress or in crisis. In supportive care, this is seen by two commonly encountered mismatches, namely the difference between what patients want and what their doctors think they want, and also the difference between what patients want and what their family believes they want.
As an example of the first situation, there was a study that showed seven percent of patients with breast cancer rated “preservation of their breast” as the highest priority, whereas doctors believed that number to be 71 percent.
This article describes two patients, one who had surgery for a misdiagnosis of breast cancer (there was no cancer), the other patient had surgery for cancer, but would have preferred not to once she learned about other options. The authors point out that the misdiagnosed patient would certainly trigger a significant response, investigations, root cause analyses, etc. They then go on to ask why a misdiagnosis of a patient’s preference is not given the same level of response or importance.
Nor is it as simple as just asking patients what they want. There are many nuances to consider, and even when there are documented choices, how they are interpreted can be problematic. Another article describes the situation of a patient with a Living Will who suffered a cardiac arrest.
Do you or don’t you resuscitate him? The answer is, yes, you do! A Living Will is not the same as a Do Not Resuscitate (DNR) order, and actually only applies when a patient is terminally ill or in a persistent coma and cannot communicate. This patient was not in either situation. There are also cases of unwanted treatment being litigated, such as unwanted transfer from a nursing home to a hospital emergency department.
We need to spend more time listening to our patients, understanding where they are in the heads and in their hearts. Only then can we hope to match our treatments and interventions to their goals.
Last Updated: November 5, 2018