Oncology and Communication Education

This post is in relation to the earlier one about doctors and bedside manner.

The New York Times has done a really good story on oncologists, and the delivery of the hardest message to give a patient, telling someone they are dying. The article reports that an oncologist will give bad news to a patient countless times in their career and little even have training for it.

According to one estimate, over the course of a career an oncologist will break bad news to patients about 20,000 times, from the first shocking facts of the diagnosis to the news that death is near.

Despite all the practice, it is the rare doctor who is any good at these discussions. And while some medical schools now offer basic communication courses, more sophisticated training for specialists is uncommon. One recent survey found that less than a third of oncology training programs attempted any form of communication training; only about 5 percent of practicing oncologists have had any.

"The general feeling has been that these are not teachable skills - that either you have it or you don't," said Dr. Anthony Back, an oncologist at the Fred Hutchinson Cancer Research Center in Seattle.

Also, the article states that even experienced doctors have trouble when giving bad news to patients, even when that patient is an actor.

But even they, when they first come face to face with an actor playing a cancer patient, routinely lapse into the awkward, defensive "medspeak" patients know so well. They mumble about "abnormal laboratory findings," "concerning small shadows," "evidence of some lesions in the bones."

Medicine is finally putting more and more of an emphasis on not just the science of it, but also the art of it. Good bedside manner and learning how to give bad news to a patient are all part of this. Medicine has changed so much over the last 50 years, but the basics have not. It seems medical schools and fellowship training programs, are now getting back to the basics.

Doctors Learn How to Say What No One Wants to Hear [NY Times]