AFTER CANCER: DO I HAVE TO PREPARE FOR MY FOLLOW-UP VISITS?

Patients often complain that doctors focus right away on the physical problems, ask countless questions, and never have enough time for explanations or for just a normal conversation. Many patients recoil at the idea of preparing a list of questions and problems, feeling that they should not be treated like a car being brought to the shop. Or they worry that a list would make them look like a hypochondriac. Patients understandably want to feel that they are being treated like a whole person.

The purpose of each follow-up visit is for you to get your needs taken care of and for the doctor to be certain that everything is being done to ensure that you do as well as possible. In order for you to receive the best care, you and your doctor must work together as a team. Your job is to describe your problems and explain your concerns as clearly as possible. Most people do this best with some advance preparation.

Like everyone else, doctors face time constraints. What you may interpret as abruptness may be your doctor’s attempt to be organized, so that the information obtained is complete and accurate and so that your most serious problems are addressed. A vague, unstructured discussion or a focus on one issue may make you feel better emotionally but divert your doctor from the important issues.

Your oncologist is trying to understand your medical situation, find the best solutions to your medical problems, and prevent new problems from occurring. Most oncologists truly care as much about your emotional well-being as about your physical well-being, but focus primarily on the physical in order to maximize the chance that you are physically well enough to deal with the emotional. From a practical viewpoint your doctors are the only people who can address the major medical issues (as opposed to nurses, social workers, counselors, and so on). If they do not take care of these questions and problems, no one else can. Also, if oncologists did not maintain some distance and objectivity, they could not make the best medical decisions for you.

At the beginning of each of your visits, you are like a mystery person. Even if your doctor has been taking care of you for years he or she has to figure out what your problems and concerns an that day in order to address them. And, as with any mystery, the more clues you provide, the faster and more accurate will be you doctor’s solutions.

If you just show up for your visit and expect to sort through your problems and questions while your doctor listens, or if you expect your doctor to figure out your problems and question: through doctor-directed questions, you may spend most of the visit just figuring out what your problems are.

It is much easier for everyone if you tell your doctor, «I have had some cramping in my stomach and have noticed some blood in my bowel movements for the past three weeks,» than if the doctor has to keep prodding: «Are there any problems?» «Yes.’ «Can you tell me what the problem is?» «My bowel movements are different.» «How are they different?» «I think there has been some blood in them.» «When did this begin?» «Let me see . . . today is June 12, so it must have been two … no wait, it was about three weeks ago.» «Do you have any pain?» «Yes.» And so on.

There is an old joke about the patient in the emergency room who complains of stomach pain and vomits blood. After the usual series of questions and physical examinations, the emergency room doctor orders an X ray, which shows a razor blade in the stomach, and asks the patient, «Why didn’t you tell me that you swallowed a razor blade?» The patient answers, «Because you didn’t ask me!»

You are not expected to be an expert at describing your symptoms and problems, but it will be less stressful for you if you are prepared to discuss your problems and concerns. You will be better served, too, because the information you provide will be more accurate and more complete. How many times have you left the doctor’s office and realized that you forgot to mention something important?

Your emotional, social, and spiritual concerns and problems are just as important as your medical ones. Your oncologist absolutely needs to be aware of cancer-related sexual difficulties, problems with your children, problems with insurance or your job, and the like. By making your doctor aware of these issues, he or she can better understand your condition, better understand you, and direct you to appropriate people who can help you deal with your problems.

It does not make sense, however, for your oncologist to be counseling you at length, trying to resolve these issues. It is in your best interests if your oncologist directs you to the people who can help you.

Ironically, the more focused and direct the exchange of information at the beginning of your visit, the more time and energy is left to discuss your emotional and social concerns, to relate socially as two people, and for your doctor to offer comfort and support.

You are a person, with feelings and a soul. When you go to your doctor, you are not taking your body to the shop; you are trusting your being to another person. Your doctor can best care for you through a team effort at understanding and solving your problems.

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