Delivering Grim News – It's All In How You Say It
Greta Austin has spent a lot of time in medical waiting rooms.
Two years ago last fall, her father came to Seattle from Wisconsin for treatment, and she sat with him at the Seattle Cancer Care Alliance.
“It’s this moment of incredible anxiety,” she said. “You sit in a waiting room, and you’re looking out at one side, you can see the highway going north to south, looking out you can see the lake going to the ocean.”
That was a metaphor for the people in the waiting room, not knowing what direction their lives would take. They’re waiting to get treatment, to hear about test results – waiting, not knowing. “It’s a very liminal place,” Austin said.
Austin’s father had a scan to check out a blockage in his stomach. The family was about to meet the oncologist to go over the results. It didn’t look good.
“There was a cancerous mass in the pancreas,” Austin said. “It had metastasized and blocked the bottom of his stomach.”
Hearing that news was hard. But what struck Austin was the manner of the oncologist at SCCA, Dr. Tony Back. “The way in which Dr. Back delivered the news was with so much compassion and humanity,” she said.
There would be many more meetings with Back. At each visit, the family would list their questions and worries, and he would answer them one by one.
“He’s dealing with a tough crowd, my two siblings, one is an oncologist, one is a pathologist,” Austin said. “He grounded his answers very much on the facts, but it was just never about the facts. It was, ‘Let’s give you the quality of life the best that we can.’”
Austin said Back took the time to get to know her father – a man who loved basketball, and who was an avid birdwatcher with an enviable list of birds he had seen.
Health care is usually focused on treatment. But there’s growing recognition that a doctor’s communication skills are just as crucial. Traditionally, that’s not been part of doctors’ medical training.
But that’s slowly changing.
Back said there’s a myth that doctors who are warm and friendly may not be up on the latest in medicine, and those who have the science down are cold. “You don’t have to choose between those two things,” he said.
Back has been interested in how physicians communicate with patients since he was a medical student. One incident, in particular, stands out.
Back was part of an oncology team making rounds at a hospital. An elderly patient had been admitted the previous day for a blood disorder. The team was on its way to see her. The attending physician asked the doctor in training about the patient.
“The fellow looks up at him and said, ‘Well, Mrs. So-and-so died.’ Just like that. The attending physician kind of nodded and goes, ‘She was an old trout.’”
Back couldn’t believe what he had just heard. “I was like, ‘Oh my gosh, that was so callous!’” He didn’t know her, but she was frail. She could have been someone’s mom. “We clinicians need to do a better job with seeing the humanity in everybody,” he said.
The incident led him to believe that doctors aren’t equipped to talk about such intense situations. He realized he wasn’t getting that kind of training in medical school.
He sought his own training over the years. Midway in his career, he started a nonprofit program to help doctors learn from their blunders. It’s not just knowing what to say, but also learning what’s important to patients.
What Back likes to do is ask patients to show pictures from their cell phones.
“It will tell you a lot about what’s important because who’s in the picture, what they were doing, how long ago that was,” he said. “Those are all clues to me about whether someone is living in a way that they’re getting some living done every day, as well as taking care of their illness.”
Back said studies show that when patients are plugged in to what gives them joy, they do better. They’re able to weather the challenges ahead.
These conversations helped Greta Austin’s father think about what he wanted to do with his remaining time. A big goal was to go back to Wisconsin to see the warblers in their spring migration.
“If you had told me that he would go back to see the migration when he first came to Seattle, I would have said no way,” Austin said.
But he did. He lived almost two years and was there for big family events. Austin said the experience made her appreciate that medicine isn’t just about science – diagnosing the illness and coming up with the right treatment. It’s also about communication, the ability to bring out what matters most to people.