Physician-patient communication about breast cancer. A challenge for the 1990s

Rose Kushner, a well-known breast cancer patient advocate and medical journalist who contributed immeasurably to the changes that have taken place in breast cancer management today, summed up the communication dilemma succinctly. She stressed the importance of communication from physician to patient and from patient to physician. "In order for it to work [well]," she said, "it has to go both ways." The essence of a mutually cooperative endeavor in health care assumes that reactions from both parties affect the nature and outcome of the interaction. Therefore, it is mandatory to examine the reciprocal flow of factors that shape the physician-patient interaction. Although public testimony often conveys the conviction that physician communications are limited or altered in an attempt to protect patients from emotional upset and that withholding information is in their best interest, a literature review demonstrated that this was not so. Interestingly, today, a contrary trend may be emerging, where some physicians are so forthright and blunt in their disclosure that the impact of a guarded prognosis is felt as an assault and carries with it a connotation of certainty for disaster. As was stated earlier in this article, a most useful beacon to guide the physician in this dimly lit path is the notion that "congruence not candor" direct the disclosure. The physician-patient interaction is a unique and somewhat fragile connection that must be viewed as more than an implicit service contract. It is a special collaborative effort that requires continuous monitoring and assessment in order to maximize gratification for both parties. Individuals on both sides of the stethoscope have feelings and needs that can operate to enhance or sabotage optimal physician-patient relations.