The Telephone Is Not Okay
October 2007
My friend, a retired professional woman, receives a phone call from her physician.
“Good morning, Susan. I am sorry to tell you that your biopsy was positive.”
“Does that mean I have breast cancer?”
“Yes, I am afraid it does.”
“Thank you.” She hangs up, is shaking, and starts to cry. She is alone at home because she has no living relatives. She cries off and on all morning and, as time passes, many questions come to her mind: What kind of cancer is it? Has it spread? What kind of treatment am I looking at? How soon will I die? Her doctor, on the other hand, goes on with his work at the office. He calls other patients with their test results and feels good about doing this in a timely manner.
Later that day the nurse from the office calls.
“Doctor wants me to schedule you for blood work and an MRI.”
The MRI appointment is made for five days hence, which means Susan won’t get any of her questions asked or answered until her next doctor appointment in ten days. When she calls the office to speak to her doctor, she becomes frustrated by the automatic answering machine. She finally manages to leave a message: “This is Susan. I have some questions I would like to ask about my cancer. My telephone number is 222-4356. Could the doctor please call me? Thank you.”
She awaits a call all afternoon. When she gets home from grocery shopping, there is a message on her answering machine: “Hi, Susan, this is Michelle, at your doctor’s office. Doctor said he will discuss your questions at your next office appointment.” She sheds more tears. Furious, she calls me, tells me her news, and we get together for coffee. As a retired family physician, I am shocked by what she tells me and what she has experienced.
This is not good medicine. When a patient’s breast biopsy is scheduled, an office appointment with her physician must be scheduled 24-36 hours after the biopsy. Then the biopsy results can be discussed in a face-to-face visit, thereby preventing unnecessary anxiety. The doctor can then fulfill his or her role as a teacher, explain test results, prognosis, and treatment, and answer any questions the patient may have. A person who picks up the phone, unprepared for serious news, cannot think of what she wants to know and ask her doctor. My friend also needs the support of a compassionate human being, her physician, sitting across the desk from her to help her assimilate the information, to help her face her mortality. This conversation is an important part of the treatment of the patient with cancer.
My friend’s experience is not a rare occurrence. The story of a man with a glioblastoma was published in The New York Times. His wife was told about her husband’s “worst form of brain cancer” on the phone by his physician.
Jerome Groopman, an oncologist, received a phone call from his surgeon in the evening when he was home alone. The surgeon said, “The spots on the scan looked like metastatic cancer.” Dr. Groopman writes: “Within moments, my chest began to ache…I was suddenly not a doctor…my mind froze. I desperately tried reaching my wife…I spent a sleepless night imagining a slow death from an incurable cancer. Despite all of my training and experience, I was overcome by fear.”1 If even a medically trained individual is “overcome by fear” and desperately needs human companionship when receiving devastating news over the phone, we can only imagine the terror that nonmedically–trained patients experience.
Telling a patient on the phone or via e-mail, “Your urine is clear now, you can stop the antibiotics” is acceptable, but that is very different from telling that same person, “You have cancer.”
The reasons doctors resort to telephone communication are several. Appointments are unavailable, it is more time effective for the physician to use the phone, and, not insignificant, it is hard to face a patient with bad news. It is easier to say, “You have cancer” into a neutral instrument than to an apprehensive patient who is sitting in the office and might become tremulous and burst into tears. However, in my view, it does not matter whether the telephone saves the doctor’s time and is more efficient. It is not an acceptable method of communicating life-threatening information to a patient. It is not good medical practice to withhold the physician’s presence, which in itself has a healing quality, when the patient has to face his or her impending death.
