Deadly Bedside Manner

BY MARK SCHOLZ, MD

Physicians are routinely trusted with privileged information, information so intimate that even a spouse may not be privy to it. Patients naturally expect their doctors to handle such information wisely and professionally. We expect a certain degree of thoughtful kindness and respect from doctors since they have unbridled access to the inner sanctum of their patients’ lives.

However, successful doctors who are caught up in the swirl of complicated and busy schedules constantly facing a stream of frightened and anxious patients, sometimes become desensitized leading to a brusque and calloused demeanor.  For these doctors, illness has become the norm, hardly something to get excited about.

A study published in this week’s New England Journal of Medicine on the incidence of suicide and heart attacks after a diagnosis of cancer, strikes a cautionary note. Dr. Fang and colleagues from the Karolinska Institute in Stockholm, reported that soon after a diagnosis of cancer the incidence of suicide and heart attacks jumped 1,000%.

The study reported that the more serious the diagnosis, the greater the risk of patients being literally frightened to death. A diagnosis of lung cancer increased the risk 2400%. The risk was 3200% when esophageal, liver or pancreatic cancer was diagnosed. With prostate cancer the increased risk was “only” 600%.

I have always had a strong intuitive sense that mishandling a patient’s psychological world could be “unhealthy.” The thought that it might be potentially deadly is sobering. 

You wouldn’t think that doctors could be so insensitive that they would telephone patients on a Friday afternoon to inform them of their cancer diagnosis.  Believe me, it happens. 

Potentially bad news needs to be imparted in a supportive environment. Emotional support comes from the physical presence of family members or friends. Professional support comes from having a plausible plan of action for treating the cancer.  In my more than two decades of treating prostate cancer, I have learned that people’s frightened concerns about the future are almost always radically worse than the truth.

The new Swedish study shows how important it is to make sure that patients with recently diagnosed cancer don’t become isolated.  Cancer patients should never be asked to “go it alone.”