Advice to Medical Students - your thoughts
Hi all, as a BCNA Community Liaison I have the opportunity to speak to a group of 2nd Year Medical Students at the University of Sydney next week as part of their Oncology Unit. The talk will focus on my experiences / interactions with doctors during my breast cancer treatment / reconstruction and the support available (especially via BCNA and our online network) but in my preparations I thought I might be able to include some feedback from this wonderful group that might help these students understand what is helpful / not helpful when working with / caring for someone with breast cancer.
A couple of my experiences include -
1) Not so helpful: The confirmation of my diagnosis wasn't give to me in person, with support, in the doctor's office, but relayed through my husband to me while I was at work 
2) Very helpful: My breast surgeon openly discussing breast reconstruction options on my first visit 
Would love to hear your feedback. Jane xx
Comments
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HI Jane,
I had the opportunity to do a similar program with some new grads at Peter Mac--it can be very worthwhile.
One of the things I have found most confronting during treatment is the exposure to students in a teaching hospital. It's part of the deal, but they can be very challenging--either individually or enmasse.
Number 1 is manners. They may be barreling around a hospital seeing dozens of patients, but they should all introduce themselves--even if they are in a pack following a Prof around. The patients' name will be above the bed, that should be a clue about how the patient is addressed. Personally is nice.
Never, ever, argue with a patient when there is someone else in the room. The doctor/student may be right, but if a patient disagrees with a course of action or has some form of complaint that discussion should be had in what ever semblance of privacy is available.
Always ask if it is OK to have even the most general conversation with the patient when the patient has a visitor. Do not assume that the visitor is a close friend or relative who may be party to any medical details. I had a doctor launch into a very detailed explanation about what had gone wrong with my implants while a neighbor--commonly referred to as Radio Oxley--was visiting. No!
The patients presence in a hospital bed does not imply that they can be handled without permission. Consent is not enduring and does not automatically transfer to anyone with a stethoscope and brown pointy shoes who wants so peer down your nightie. This is very quickly forgotten--familiarity breeds contempt and it doesn't seem to take long. BTW, what is it with the brown pointy shoes? Is it a rule or some sort of unofficial uniform for male med students? Please ask, I'd like to know.
Marg
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@Zoffiel brown SUEDE pointy shoes my son informs me is de riguer atm for med students. I’d like to add @Jane221 that some discussion be had as to post treatment likely side effects- I was fine during treatment as I knew what to expect but have gotten the jitters after when changes happen that I did not expect or understand eg nerve regeneration causing chest pains , inflamed sore breast occurring months after radiotherapy has ended. I just think ,like I think is the case in the community generally , that when treatment ends they expect all is well and the med students need to know that is not the case - they need to know about the impacts it has on ours and our family’s lives for years to come even though they may not be able to assist us in many areas.5
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For a better understanding of side effects, two that come to mind immediately are neuropathy and fatigue. No doubt your talk will emphasise the importance and value of BCNA however I'm of the view that is where most of us get the comfort and understanding of the side effects.............I liken it to the old saying "don't mention the war"..............they are unspoken or breezed over quickly in a medical setting. It is the forum that gives us the comfort we are not alone and the support to understand and accept.
Ony@Jane221 Jane that is a great thing you are doing!
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I'd like to suggest be proactive. When someone says they have have a bit of tingling, ask about it and suggest whatever you can to alleviate it, don't wait till they are hobbling, dropping stuff and panicky. Ask if you are keeping an eye on your arm fluid if you have had an axillary clearance. Investigate the benefits of massage for persistent seromas.
Be polite, tell people your name and ask theirs. But don't be familiar, I am not your dear.
Try really hard to read the file before you talk to a patient - asking someone who has lymphoedema, peripheral neuropathy, had chemo, lost a breast, and now appears to have atrial fibrillation if they are anxious about anything, deserves the answer it got!!
My lovely surgeon discussed options for surgery with recommendations, breast reconstruction at the start, never hurried me (actually preferred to wait) and totally accepts my decision not to do reconstruction at all. I haven't had too many things I have run to him about, but each one has been handled thoughtfully and without rushing. He celebrates every clear year with a hug. My oncologist can sit and have a robust discussion about some aspect of treatment without getting all defensive and seems actually to welcome my interest and questions.
And there are better ways to deal with sapped morale or possible depression than taking pills. Be open to other disciplines and a more holistic approach if possible.
Thank you for asking, hope it goes really well.
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I agree with the others, manners are totally important. Also please remember there are people attached to the boobs you want to look at! To the male registrars, at a certain point touching to check for lumps becomes kinda awkward if it goes on too long!1
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Always give advice on reconstruction options, that way patients can make informed decisions. Unfortunately still today it is left to the patient to be proactive as was the case with me. Not everyone may want to reconstruct, but we all deserve information so we can decide.
Always be kind. I remember my beautiful breast surgeon talking to the anaesthetist as I was being wheeled in for my mastectomy after a recurrence very soon after treatment complete. He gave me a tiny pat on the shoulder and told the anesthetist to be kind as I'd had a very rough time. I really appreciated this small
gesture. Good luck with your talk.
Paula xxx
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I think what I value in a doctor is their ability to listen to me, and show concern for me as a person, not a diagnosis. We are individuals with different opinions and the right to say yes or no to treatment. Inform patients about costs, reconstruction options and new treatments that are available.
Keep an open mind and realise that survivorship is often more difficult than active treatment psychologically and side effects continue for many people for many years often impacting on their quality of life. My favourite health care professionals have held my hand as I fell asleep under anaesthetic, a nurse who tucked my feet in during chemo and my surgeon who shares a joke with me and lets me know she’s human.
Doctors need to work as part of a team and patients are part of that team and an active part. I sometimes feel broken and I rely on them for support. Young doctors need to know that treatment is a balance of so many factors and sometimes that balance looks different from different perspectives. Don’t forget to care and make sure to read the BCNA guidelines for breast cancer treatment.
Don’t tell people about a diagnosis of malignant tumour in the middle of a corridor of a busy hospital where they have nowhere to go to process this information but a busy ward. Patients listen to every word you say and read far more into it than you are aware of. We can also hear what you say outside our rooms.
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Couple of small things but think it says a lot about my surgeon - his staff were very busy one morning so he was taking calls and booked me in. Yesterday at my appointment my husband was quite touched that he spoke to him by his first name. He has a light but perceptive touch and sometimes makes his point with gentle humour - he is always human and relates to us as the same.2
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Press very firmly that you're treating the person as well as the disease. They will come to a point where they will see the body the way a mechanic sees a car and forget that their machine is a person. Holistic care, so important.5
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Just my experience because I have to know everything!
Helpful -
info sheets on side effects, and if possible ways to deal with them.
copies of all tests done, so I can give them to my GP and refer to them myself
A patient filter on your thoughts when talking to the patient. Mentioning stage 4 cancer when discussing a CT scan for lung nodules to a patient in hospital on IV antibiotics during chemo when they have been diagnosed with stage 2B is not helpful.
*****Remember patients hang on every word you say!********
Information on what will happen with chemo therapy, procedure, a info sheet could be handed out.
Discussion on drugs used, reasons why, possible long term side effects.
My Oncologist gave me a choice of 3 regimes, using different drugs and we decided on one based on family history of heart disease, my age and health, and desirable length of time of treatment. I felt involved, understood as much as possible the reasons for choosing the drugs and had my family health history considered.
Assessment as to whether a portacath is possible/desirable before starting treatment.
Discussion of costs of everything, don't have to be asked.
Information on support groups in the area. Check that the patient has that information, don't assume that they will get it at another specialist or treatment centre.
It can just be one question, a referral to the information wall in the rooms or a handout sheet with contact details for support groups relevant to the patient. People fall through the cracks in the information network.
Not helpful-
recommending treatments without any discussion of costs, even if there are none, don't assume the patient knows this, it can be a great cause of stress not knowing if you are going to have a big bill.
Assuming the patient knows anything!
Just because things are standard practise to someone in the field, the new patient knows nothing in a lot of cases. And even if they do, telling them the basics again doesn't hurt.
But don't tell a patient that a certain pattern will be followed by another specialist unless you know for certain that it will.
I was told that I would have a certain pattern of chemo by my surgeon, and when the Oncologist told me I would be having another pattern I stressed that it wasn't what I was told would happen.
There was so much being discussed at that Oncologist appointment that I didn't get to question that.
Telling a patient that things will happen a certain way and then they don't. Be up to speed on current procedures for everything you are recommending, scans, blood tests, chemo preceedures, hospital admission, in an unfamiliar situation, if things are not done the way that you have been told they should or will be done, it can be very stressful not knowing if the proceedures are being followed the right way.
I question now, but didn't in the first instance and some people will be too sick or too nervous to ask.
Just a few things I can think of at the moment.
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Be an expert - a thorough expert - on any drugs that you are giving to your patients. Don't guess. Know what you are talking about and tell the patients the real risks. Don't gloss over important things. For example, don't tell the patient her hair will grow back when it might not. Never minimise the impact of hair loss.4
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Maybe the students might be able to read this blog a little to hear our stories1
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Focusing truly on patient-centred care: communicating well (openly, honestly and with respect and compassion) with patients; enabling them to feel in control; asking about them not just their cancer; spending time and allowing for questions; discussing all options available and empowering patients to make the ultimate choice (informed by experts) of what will happen to them; being present, looking the patient in the eye and seeing the human being (mother, sister, wife, daughter) in front of them.3
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Most important thing to me my surgeon came from behind the desk sat inbetween my husband and me and the broke the news, she then went out and made us a coffee and bought it back in and said so guys lets talk about a plan we will do together. I felt like l was not a number but a human being.8
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Wow, so many great pieces of advice, thank you all. My focus is the person always comes before the disease / diagnosis and those small acts of kindness, compassion and understanding can make a huge difference to how we feel we have been cared for, so it's been lovely to read all your thoughts about that in particular. I also struggle with side effects post-treatment so this will be another area I will be touching on. Thank you @Unicornkisses - what a comprehensive and well-thought out list, will definitely add those in. I think I will also take up your suggestion @Romla and print out a copy of all your comments from this post for them to have a look at - good idea. Wish me luck - I hope I don't get too distracted by their footwear though @Zoffiel
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