phoenix5 logo This is an archived copy of an original page from The Prostate Cancer InfoLink site that went off-line in February, 2001. It is reproduced at Phoenix5 with the permission of Vox Medica.
More Prostate Cancer Pages at Phoenix5             About this archive

logo for prostate cancer infolink
click here to go to Where To Begin? click here to go to Diagnosis men click here to go to Treatment menu click here to go to Support & Help menu click here to go to Home menu

The Six Laws of Patient-Physician Communication
Part II

Last Revised May 15, 1997.

The six laws of patient-physician communication | About time

In Part I
Introduction | Questions patients ask their doctors |

[This document was split to improve load time.]

The six laws of patient-physician communication

The following six "laws" about communication between physicians and patients have been put forward for guidance only. These laws apply to physicians and patients, to family, to friends, and to anyone else involved. We have interpreted these laws in the context of discussions about prostate cancer, but in fact they apply in a host of other settings. Like all the best laws, they are less than perfect. Your attorney will not be impressed!

The first law of patient-physician communication: If your expectations are reasonable, it is reasonable to expect them to be met.

This is not the first place someone has suggested that patients sometimes expect the impossible from their physicians and physicians sometimes expect the impossible from themselves. However, it is a critically important aspect of the relationship between an individual physician and an individual patient. As the patient, it is vital to consider what it is that you expect from a physician. For the physician, it may be equally vital to consider what you expect from yourself -- because that will influence what you can offer to the patient.

Every conversation between a physician and a patient will be affected by expectation. Sometimes those expectations are normal and reasonable. For example, if your physician suggests that you have a PSA test, it is normal and reasonable to expect the physician to explain what a PSA test is and why he thinks you should have such a test. However, expectations can also be abnormal and unreasonable. Not all physicians believe that PSA tests are appropriate for all males over 50 years of age -- despite the recommendations of the American Cancer Society and the American Urological Association. It may be abnormal and unreasonable to expect a physician who does not think you need a PSA test to give you one. You, of course, have the perfect right to seek another physician who has a point of view more in concert with your own.

Something to ask yourself: Are your expectations reasonable?

The second law of physician-patient communication: Mortal men and women are not divine beings. They should not be asked to work miracles, nor should they ask other mortal men or women to work such miracles for them.

Prostate cancer is not a "nice" disease. It is predicted that it will kill about 41,800 Americans in 1997. However, every single one of those 41,800 men will -- at least once -- have or have had the hope that he can be cured of his disease. It is normal, and proper, and human to have and to hold such hope. Without such hope we would be less than we are.

Just as patients hold such hopes, so do physicians and other health professionals. The people who spend their lives looking for better and better ways to treat prostate cancer have all -- at least once -- hoped that the research they were doing was the next step toward a new way of curing this disease. The clinicians who treat prostate cancer every day have all had patients whom they hoped -- reasonably or unreasonably -- to be able to cure.

Finally, of course, family and friends have hopes: hopes that their father or brother, husband or son, friend or lover, will be able to beat their cancer and return to a normal life.

Deep down within us we all know the difference between hope and prayer. Hope is born of the human belief that, when we make a supreme individual effort or we work together with others in a special way, we can achieve things we may be unable to achieve under normal circumstances. Prayer, on the other hand, is born of the belief that some things are religious or mystical in their nature; many people support the view that through prayer, sometimes, the seemingly impossible can be made possible by the intervention of a divine being or principle.

Something to ask yourself: Are you asking for a miracle?

The third law of physician-patient communication: Share your fears with others. If you hold them to yourself, they will consume you.

We all have fears, whether we are prepared to admit them or not. In Western society today, fear of cancer is widespread. It has become a part of the cultural landscape just a fear of the plague must have been a part of the cultural landscape of the European Middle Ages and fear of slavery must at one time have been a normal consideration for every free African-American.

It is interesting that we so often use the phrase "fight cancer." We expect it of the patient. We expect it of the doctors. Fear can induce a whole range of biological responses which offer us potential survival benefits in different situations -- specifically including a fight. It has even been suggested that fear can stimulate the immune system and thus assist the sick to get well. Perhaps that is also true.

Patients and family members often have fears. Few of us actually want to be sick. Surely none of us would actively seek to have a disease like prostate cancer. All too often, however, we get our fears mixed up. Our fear of sickness becomes the fear of the unknown. Or our fear of the unknown becomes the fear of loss.

Physicians also have fears. For surgeons there is always the fear of operative failure. For all physicians in general there is the constant fear that they may have missed some clinical sign or symptom in a patient which would have led them to make a more informed decision. In American society today -- rightly or wrongly -- many physicians are also fearful of a legal system which appears to them to be able to punish them for carrying out what they believed to be good medical practice.

Something to ask yourself:With whom can you discuss your fears?

The fourth law of physician-patient communication: Tell the truth in so far as you feel able. The truth never hurt anyone as much as a lie.

For many people, physicians, like lawyers and bankers, are figures of authority to whom they should simply say, "Yes," when they are told what to do. Other people have a natural tendency to question everything and to act only on their own beliefs and prejudices after seeking and evaluating whatever information they feel they need to come to what they consider reasonable conclusions.

In the face of a disease like prostate cancer -- although this rationale applies to almost any long-term, life-threatening, and debilitating disease -- there is a need for mutual trust between patient and physician if the best outcome is to be achieved. The patient needs to trust that the physician will listen and will give that patient the same advice he would give his own father if his father had the same symptoms of prostate cancer. The physician needs to trust that, when the patient says he will act upon the advice of the physician, he will indeed take that action, and not simply go and get another opinion just because he did not like the one he was given. If you want to get a second opinion, that's fine; but you should be honest with the physician about it.

Some physicians tend to be less than forthcoming with all of their patients. Perhaps that is just their nature, or perhaps it has to do with their training. If you believe that your physician is not telling you everything that you want to know, you should explain that to him or her. It is easy to do very politely. All you have to say is, "Doctor, I don't want to seem difficult, but I get the feeling that there are some things that you aren't telling me. Is there anything else that I need to know?"

In the end, the way you and your physician relate to one another will probably have more impact on your treatment than any other individual technical skill. If you relate well to your physician, you will be able to say to him or her, "So if you discovered that your father had these symptoms tomorrow, what would you recommend that he did?"

There is nothing wrong with letting the physician tell you what to do ... and there is nothing wrong with asking a thousand questions and then making up your own mind. The crucial factor is whether you and your physician both understand and accept the situation as it is. What tends not to be a good idea is if management of disease is dictated either by the physician to the patient or by the patient to the physician with little or no regard for the expertise of the physician on the one hand or the opinion and personal input of the patient on the other.

Something to ask yourself:Do you want the physician to take charge, or do you want to take charge with your physician's guidance?

The fifth law of physician-patient communication: If you are the patient, always ask the doctor what he would do in your circumstance. If you are the doctor, always ask the patient what he would like to be able to accomplish if treatment fails?

We are all biased by our experiences, our education, and our cultural attitudes. Sometimes, those biases are valuable. Other times they can become nooses around our necks. In the face of a diagnosis of prostate cancer, you may want to be very aware of the possible biases of your doctors if you are a patient and your patients if you are a doctor. Every little bias counts. Let's see if we can spot some. How about these?

  • "He's the doctor. Just do what he tells you."
  • "If I can't have sex I won't be a man."
  • "Smoking cigarettes never hurt anyone."
  • "Eating meat gives you cancer."
  • "I didn't pay Social Security for 40 years to be told you can't cure me!"
  • "Look I know this is difficult for you, but we need to schedule surgery quickly."
When you talk to your doctor about your prostate cancer, you need to remember what he or she is. Medical school and clinical training teach a physician first and foremost how to practice medicine. If your doctor is a specialist, such as a urologist or a radiation oncologist, he or she has been taught even more specifically how to practice those specialties. It is not reasonable to believe that in many cases a radiation oncologist would recommend to a patient that the patient have surgery when he or she believes that radiotherapy works just as well or maybe better. Conversely, it is hardly likely that radiation therapy will be the first form of treatment recommended by a surgeon if you have localized prostate cancer. This is your prostate cancer, and you should always remember that. Whatever the doctors suggest or recommend, in the end the decisions are yours and you are the one who will have to live with those decisions.

Something to ask yourself:Are my prejudices stopping me from making smart decisions?

The sixth law of physician-patient communication: You will never truly trust a person with whom you feel uncomfortable, and it is hard to be honest with someone you don't trust.

We are a less formal society than we were 40 or 50 years ago. People are less inclined to be patient with each other. And we all tend to take each other for granted too much of the time.

The practice of good manners helps us to feel comfortable with people we do not know well. Good manners are simply a set of tools which have been designed to help us through unfamiliar situations with the minimum of discomfort for all concerned.

The application of good manners by both parties can profoundly affect the relationship between patient and physician. We have all heard the stories about the good physicians who listened carefully to their patients. Equally, we have all heard stories of patients who were rude to their doctors because it just was not possible for them to be seen immediately. If you make an appointment to see a physician at a specific time, you should reasonably expect to be seen. Similarly, if the physician makes an appointment to see you at a specific time, he should reasonably expect you to turn up!

If your physician wants your respect, he or she will be on time if he or she can manage, will apologize if he or she has been delayed, will be clean, tidy, and ready to deal with you, will listen to what you have to say, will ask you questions politely, and will check with you carefully to be sure you understand what he or she is saying. Conversely, if you want the physician's respect as a patient, you also will be on time if at all possible, you will be ready to comply with the physician's need to ask you questions and give you any necessary physical or other examinations, you will listen with care to what the physician has to tell you, you will ask questions politely, and you will clearly indicate to the physician those issues which you do and you don't understand.

About time

We have already talked about being on time. It is just as important for patients as it is for physicians. However, there is one other matter which we need to handle and which can also affect the ways in which physicians and their patients interact. It has to do with the amount of time which an individual patient needs from his physician.

A good physician wants to give patients as much of his or her time as possible. However, no physician can give all of his time to a single patient. When you need to be able to gain information from your physician, try to make sure that you are not holding him or her up if there are other patients waiting. If the doctor is delayed, and you are the next patient in line, think how you would feel. You can always ask the doctor if you can make another appointment to come back and talk some more. Or you can offer to wait until the doctor has seen the other patients who are scheduled.

The point, of course, is that we live in a world in which there are multiple demands on all of our time. It is difficult to fit all the things we would like to manage into our lives. The least we can do is remember this, and try to consider others when we plan our days. The way we use time affects the way we talk to each other: in this case it affects communication between doctor and patient.

Where to Begin?    |    Diagnosis    |    Treatment    |    Support    |    Home Page

The content in this section of the Phoenix 5 site was originally developed by CoMed Communications (a Vox Medica company) as part of The Prostate Cancer InfoLink. It is reproduced here with the permission of Vox Medica.

Go to Phoenix5 Main Menu