For Physicians

Guidelines for Physicians

Dr. Murray F. Brennan

Chairman, Department of Surgery

Memorial Sloan Kettering Cancer Center

In the last edition of ESUN, Dr. Brennan presented some Guidelines for Patients and Caregivers. Although one might think it presumptuous he has previously written similar guidelines for doctors, particularly in the context of the younger physician just beginning to take care of the patient with cancer. The following are those guidelines:

1) Be consistent – tell the truth! Nothing destroys a patient’s belief in his doctor more than learning that the doctor has not been truthful. This can take many forms with the most appropriate being to promise what you can not possibly deliver.

2) Telling the truth does not mean taking away hope. No physician can or should pretend to play God. There is always hope – it is where the future is. Every physician remembers the patient who he or she did not expect to do well, who was back a year later reminding the doctor of his pessimistic outlook. So when you do tell the truth, it should never be in the context of there being no other care available.

3) Do not promise what you cannot deliver. For surgeons, this means do not promise a curative operation if it can not be delivered. Nothing destroys the faith of a patient in the doctor more than the doctor failing to fulfill promises. It is even more frightening if you promise what another doctor might deliver and it is not possible. No matter how much you want them to be true, if they are unrealistic, do not promise them.

4) There are no foolish questions, only intolerant answers. For the patient every question is important. On occasions you, the physician, will feel that the question is inappropriate or irrelevant, but for the patient that is not the issue. You can only destroy the faith of the patient by intolerant answers.

5) You can have a bad day, but not every day! Patients understand when you have an occasional bad day. We all have sick family members, a wayward adolescent, or we may not feel well, but it is not a choice for that to be everyday. If you are having a bad day every day, then you need to take time away from the patients and solve your own issues before moving on.

6) Your staff reflects your personality. If a patient calls and is greeted inappropriately by a member of your staff, you are held to blame. Test it out sometime, call your own answering service or call to hear what your voicemail message sounds like. Is it how you would like to be greeted if you were a patient or a referring physician?

7) The patient has rights, but so do you – neither should be abused. If a patient does treat you inappropriately, it may well be merely a reflection of their anxiety, stress or angst, but you are not required to accept abuse. Even the most distressed patient can respect you, as they wish to be respected. It is important to recognize that we all have rights and we all deserve to be treated as we would wish to be treated ourselves.

8) Be affable – be available. If you want to develop a rewarding practice then you do need to be available, you do need to be affable. Looking after cancer patients is not a part-time job. It does cut into your own time and the time with your family, but you do have to be available and you do have to expect that inroads will be made on your time. You may not have the command of your life that you would hope, but looking after patients can never be a part-time occupation.

9) When there is no more treatment you do not say, “Go away,” you say, “An operation may not be indicated, but I will continue to care for you.” Nothing distresses a patient more than to be abandoned. Whether you intend it or not, the concept that you no are longer available for them implies that there is no more treatment and there is no more willingness to help, and no more hope.

10) Arrogance truly does breed contempt. The patient has the right to be contemptuous if you are patronizing or arrogant, just as you have contempt for others who treat you in such a similar way.

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