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Globe Editorial

Evidence mounts of problems in doctor-patient relationships

December 30, 2010

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THE DOCTOR-PATIENT relationship, rightly celebrated as the beating heart of the American health care system, needs a little treatment on its own. Studies over the past year have shown that doctors often don’t level with patients about a poor prognosis, even if it means the patient will undergo unnecessary procedures. Talk about end of life decisions gets short shrift, too, partly because it’s not always billable. And now comes evidence that cancer patients don’t feel comfortable telling their doctors about the alternative treatments they’re pursuing.

There are understandable reasons why doctor-patient relationships can be difficult. A cancer diagnosis, especially if the disease is advanced, is a devastating moment in a patient’s life. Oncologists, usually the bearers of the bad news, face a major challenge in designing effective therapies. In the tireless battle against a disease that is invading the patient’s body, many oncologists become, in the eyes of their patients, the gatekeepers of treatments and the brokers of promise. Patients can begin to feel powerless.

In an effort to take control of their condition, many patients seek alternative therapies, though they don’t always tell their doctors about it. A study of Seattle prostate cancer patients published this month found that 52 percent of 379 patients surveyed used one or more alternative therapies, but only 43 percent of those patients discussed it with their primary doctor or oncologist. Common alternative treatments include mind-body therapies such as relaxation techniques but patients also report turning to acupuncture, special diets, homeopathy, and even magic. The idea to initiate alternative therapies comes from many sources — family and friends, television or magazine advertisements, online support group recommendations, and more. The main reasons for not telling doctors about these therapies, according to patients surveyed, are fear of a negative reaction, or a sense that their doctor simply does not believe in these treatments.

While it is true that the scientific efficacy of many of these therapies has not been proven, doctors should keep in mind that benefits to cancer patients cannot exclusively be measured through regression or remission. Improved quality of life is also a benefit, and if a patient feels empowered and less stressed by seeking a harmless, if therapeutically ineffective, therapy, that’s also success. A doctor who discusses these treatments with his or her patients, offering advice on which ones may help improve quality of life, does a much better service than a doctor who dismisses anything that does not fit the Western medicine mold. An added benefit is that doctors might be able to spot troublesome therapy combinations. For example, some herbal supplements could potentially interfere with the efficacy of some treatments. A cancer patient that goes on a special diet might rapidly lose weight, which an oncologist could misinterpret as a sign of the patient advancing into late-stage cancer.

Given the relatively widespread use of these therapies among patients, doctors should make sure they engage in a constructive dialogue about this topic every time they make a diagnosis. There is much to be gained, and failing to acknowledge their patients’ use of these methods is not going to make the issue go away.