Sometimes we forget the patient needs to know R.G. WILSON, MD One of the listed duties of the secretary general is to communicate; the terms of reference place this duty at a superior level in terms of government, other health related national organizations, divisions of the association and other ethereal bodies. My predecessors were scribes or scribblers, either regular or occasional, and in a similar vein, I am expected to be a contributor. During my professional career I have received my share of rebuffs from scientific editors. Most of my contributions h&ve been pedestrian pieces related to announcements or explanations of policy, fee-schedule changes, notices about upcoming events and the like not the sort of prose that is destined to stand the test of time. Perhaps I should be grateful that CMAJ is willing to consider the publishing of such errant thoughts as may be produced from time to time, and let us pray that at least some of them contain medicalpolitical erudition or some evidence of hard thinking. Understanding One of the features of this job is we get letters. Perhaps you will remember the closing theme of the Perry Como show some years ago, "Letters we get letters"; our theme is the same, but the requests are not for popular music, but pleas for understanding. Many patients, from time to time, find themselves unable to communicate with their doctors (or any other person associated with their health care for that matter), and that inability to talk meaningfully leads to frustration. One of the repetitive complaints arises from that group of persons defined as chron-
ically ill, frequently sufferers from cancer in one form or another. These individuals, by and large, obtain their ongoing care in "clinics", and whether we like it or not a visit to such an institution is often a dehumanizing and defeating experience for the patient. In such a situation, identity often appears to be lost, appointments are routine, patients are asked to be present on time and the doctor is often late. Frequently the patient care situation is a teaching one, with teaching at all levels of skill and knowledge. Privacy is assailed, with names being called on a public address system, assembly line examination and the final blow an unnerving episode related to the drawing of blood with a collapsed vein or the inept attention of a trainee technician. Patients do cope with these problems. Sure they complain, but usually to the family or a friend seeking compassion relative to the indignities of care. However, it is really the information gap in such situations that is often the most critical. I refer to the failure of the system to recognize that in such routine re-examination or recheck, a treatment or tumour clinic, even in these enlightened times, fails to recognize the human right of the need of the patient to know. The staff, the student, the consultant all assume that the patient is aware, that simply noting his progress, a cheery "come back next month" is all that is required when the patient is hungry for talk. He needs to know and often has no one to turn to; even his family physician, frequently unaware of the ongoing clinic activity, is unable to help. These problems are not new; doctors are aware and are constantly reminded
of their responsibilities. No one means to be unkind but because of the pressure of time and a certain amount of sick-parade medical care, an assumption prevails that the patient knows more than he does or has no doubts. Others recognize this lack and try to fill the void; the nurse, a social worker or a volunteer may try to help, but in discussing the course or outcome of a disease process are soon out of their depth and ultimately must turn to the physician for advice as to how to proceed or how to inform; and in fact the physician must make and take time. A patient's plea This plea results from a letter (indeed a short article) from a patient who says in part, "Beginning my 5th year of therapy in two centres - one for cobalt, one for chemo - I must consider myself a chronic patient, concerned about what is happening to me and others like me." and, "Perhaps the time has come, too, for attending staff to be reminded that patients are individuals - they do have feelings and are entitled to courtesy and respect." The letter is a plaintive cry, the plea of every patient; perhaps more distressing because of the nature of the disease. Doctors pay lip service to the need to succour, inform and help our patients; and yet in the name of education, efficiency or lack of time, we frequently subject people to shame, fear, anger or just plain bad manners. We must never cease to remember the person behind the name, behind the case, behind the number or behind the nature of the case, nor forget that the name of the game is communication.E
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ically ill, frequently sufferers from cancer in one form or another. These individuals, by and large, obtain their ongoing care in "clinics", and whether we like it or not a visit to such an institution is often a dehumanizing and defeating experience for the patient. In such a situation, identity often appears to be lost, appointments are routine, patients are asked to be present on time and the doctor is often late. Frequently the patient care situation is a teaching one, with teaching at all levels of skill and knowledge. Privacy is assailed, with names being called on a public address system, assembly line examination and the final blow an unnerving episode related to the drawing of blood with a collapsed vein or the inept attention of a trainee technician. Patients do cope with these problems. Sure they complain, but usually to the family or a friend seeking compassion relative to the indignities of care. However, it is really the information gap in such situations that is often the most critical. I refer to the failure of the system to recognize that in such routine re-examination or recheck, a treatment or tumour clinic, even in these enlightened times, fails to recognize the human right of the need of the patient to know. The staff, the student, the consultant all assume that the patient is aware, that simply noting his progress, a cheery "come back next month" is all that is required when the patient is hungry for talk. He needs to know and often has no one to turn to; even his family physician, frequently unaware of the ongoing clinic activity, is unable to help. These problems are not new; doctors are aware and are constantly reminded
of their responsibilities. No one means to be unkind but because of the pressure of time and a certain amount of sick-parade medical care, an assumption prevails that the patient knows more than he does or has no doubts. Others recognize this lack and try to fill the void; the nurse, a social worker or a volunteer may try to help, but in discussing the course or outcome of a disease process are soon out of their depth and ultimately must turn to the physician for advice as to how to proceed or how to inform; and in fact the physician must make and take time. A patient's plea This plea results from a letter (indeed a short article) from a patient who says in part, "Beginning my 5th year of therapy in two centres - one for cobalt, one for chemo - I must consider myself a chronic patient, concerned about what is happening to me and others like me." and, "Perhaps the time has come, too, for attending staff to be reminded that patients are individuals - they do have feelings and are entitled to courtesy and respect." The letter is a plaintive cry, the plea of every patient; perhaps more distressing because of the nature of the disease. Doctors pay lip service to the need to succour, inform and help our patients; and yet in the name of education, efficiency or lack of time, we frequently subject people to shame, fear, anger or just plain bad manners. We must never cease to remember the person behind the name, behind the case, behind the number or behind the nature of the case, nor forget that the name of the game is communication.E
CMA JOURNAL/FEBRUARY 19, 1977/VOL. 116 425
