I was recently speaking with a middle-aged woman (a friend of a friend) who had a month earlier seen her physician with a new complaint of constant, mild belly pain. After several studies, she was found to have a growth pressing into the first part of her small intestine, the images and location of which suggested cancer. Having sought both a first and a second opinion, she is scheduled to undergo a major operation. This surgery can be performed either via a large abdominal incision (the traditional “open” operation) or laparoscopically (the “minimally invasive” surgical approach utilizing a small camera and instruments). Her surgeon enthusiastically recommended the laparoscopic approach, as it avoids a large incision and is associated with an easier post-operative recovery.
In speaking with her, it became clear that she had never in several appointments with her surgeon asked the one question that was so troubling her: was this minimally invasive surgical approach “as likely to cure her cancer as the traditional, open incision approach?” This one question gnawed at her throughout the day and kept her up at night as her scheduled surgical date approached. But she never asked.
Some months ago, a co-worker asked me to speak with her father. Despite repeated pleas from his adult children, her father had refused likely curable surgery for throat cancer. His kids were at their wits' end, having repeatedly failed to convince their dad that this operation was his only good shot at survival. When we spoke, he had no hesitancy in sharing that he had refused surgery because the potentially curative operation would include removal of his larynx (voice box), leaving him unable to speak without the use of a “robotic” vibration sound-generating device. Simply put, he said, “I'd rather die of cancer than be unable to talk to my grandchildren.”
His entire portion of our conversation was performed staccato, his sentences punctuated by short gasps for air, and his words were raspy and forced, the result of the tumor already invading his vocal cords. I commented on this, asking what he had been told would happen to his ability to speak if he chose not to have the operation. He admitted that this one question had occupied his thoughts for some time, but he had never asked any of the many physicians who he had seen.
First the easy part: when patients don't ask the major questions that are frightening or concerning or confusing them, we physicians quickly provide answers to the most common concerns and areas of confusion. We are trained to move rapidly through our busy day by keeping patients (and their families) tightly focused on the topics that in our training and experience as physicians think are critical to address in our very limited time together. Thus in the first vignette, the surgeon likely never even considered that the woman might think he would exchange the likelihood of curing her for an easier post-operative recovery. And in the second scenario, his physicians likely assumed the man appreciated that his rasping and gasping and damaged voice clearly indicated a future with complete loss of speech should he refuse surgery.
Put simply, we physicians see dozens of anxious patients daily as we combat the increasingly unsustainable time constraints being heaped upon us. It's as if we're being tasked with selling a car every eight minutes. So we immediately tell you about the gas mileage, safety systems, and passenger capacity, as these are questions common to every new car buyer. But we can't ask each and every one of you how many cup holders you want (it seems obvious to us that you understand there are an adequate number), as we need to move on to the next customer.
Now the harder part: why patients fail to ask what’s truly important to them. See if you recognize yourself or a loved one among these common reasons:
So the two patients? She asked, and a surgeon reassured her that the minimally invasive surgical approach had the same likelihood of curing her cancer. And when he asked, a physician explained that with or without surgery, he would soon no longer be able to speak, but that only with surgery could he long survive. And so he underwent a successful surgery, and now laughs and talks with his grandchildren, who lovingly call him “Grandpa Robot!”
It’s your diabetes. Your heart failure. Your COPD. Your cancer. If you have any personal fears or concerns or confusion, ask.
So what’s the One Question You Should Ask Your Doctor? Only you know.