It is hard giving good news. I must be kidding, right? No, for an Oncologist giving news that the cancer is in remission, that the scan is normal or that the therapy is completed can be remarkably difficult. The words are easy to say, but for many patients good news can be very hard to hear. Giving good news is an art unto itself.
For many patients who have fought a terrible disease, the news that it is diminished or gone requires coping, just as receiving bad news. It sounds too good to be true. Sometimes saying “remission” or “cure” may seem like curse. A jinx. Confronted with information that all is well, many patients frantically look for wood on which to knock. Others cross themselves. I have had patients become angry with me, as they try to adjust.
These conflicting feelings are a mix of guilt and fear. Many feel guilt because they are somehow not worthy to survive an illness that has killed so many. Often we fear the future. Is the cancer going to come back?
These “good news feelings” are not a small thing. For many patients such ambivalence interferes with the ability to resume and find happiness in life. Patients who cannot accept they are healthy may become fixated on their disease. They feel that if they are not constantly and obsessively vigilant that the cancer will come back. Therefore, how physicians tell good news and how it is reinforced can be very important to their patient’s future happiness.
A skilled physician will take time to give good news, almost as much as when they give bad. Discuss in detail the testing and any perceived limits. Give a clear understanding of long-term prognosis. Be available to see the patient again in short term follow up. Most patients “in remission” need to touch base at least for a while. This allows them to balance their new life with the passed battle against disease.
A doctor’s office should be a “Kenahora Zone.” “Kenahora” is an old blend of three words in Yinglish: kein = no, ayin = eye and hara = Evil. Properly used it is meant to ward away evil spirits that might be brought on by hubris. For example, “What a handsome son you have, kenahora.” Every word said in the doctors office, should feel as if it has this protection. It is very important that patients have a place where they can openly discuss both good news and bad. There must be a feeling of safety, where words mend. A place that can never admit the evil eye.
Therefore, doctors, take your time in giving good news. Explain it carefully and remember its contrary affect. May your patients have little bad news, lots of great news and many years of health. May they again find life and be happy. Kenahora.
Comment