Hearsay

States that what physicians say is one thing but what patients hear can be quite another. Research by Tamara Sher involving patient/doctor conversations; Why patients can't or won't hear the bad news; How doctors can ensure that their message gets across.

By PT Staff, published on May 01, 1994

DOCTOR/PATIENT TALK

WHAT PHYSICIANS SAY IS ONE THING. WHAT PATIENTS HEAR CAN BE QUITE ANOTHER.

It's long been assumed that doctors are the bad guys when it comes to communicating with patients. But Chicago researchers found that's not always so, especially when delivering bad news.

"We found that the physicians were doing a fine job," reports psychologist Tamara Sher, Ph.D., of Rush-Presbyterian-St. Luke's Medical Center. "Patients were just not hearing the conversations as intended." They put a positive spin on even the grimmest of news.

Using a handheld tool of couple's therapy called the communication box, oncologists and patients rated conversations as negative or positive every 90 seconds. Observers did the same as they watched the conversation on video.

Take the most common example: Patient and doctor are discussing the severity of the patient's cancer. "As they walk away, you ask the patient how it went and he says, 'Actually the doctor says I'm doing pretty well and I feel very well,'" relays Sher. "But ask the doctor and she says, "The conversation went fine, but I had to give him some pretty bad news."'

Apparently survival instincts set in and patients can't or won't hear the bad news. "They want to believe in their doctors and feel positive about them, and it's hard to feel good about someone who is giving you bad news," explains Sher. Also, cancer treatments can be painful or uncomfortable, so patients create hope where there is none--to muster a reason to continue. Or patients may just be rejecting bad news.

To ensure the right message gets across, Sher encourages doctors to continually ask their patients if they understand what is being said.

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