Yesterday I went for my annual mammogram and my semi-annual appointment with the surgeon. The mammo technician was on a word diet, I believe. I think she had only a certain number of words to use that day. She called me by last name, and issued me curt instructions s about where to stand and when to breathe and when to not-breathe. The plates really hurt my breast, but I didn't mind. The machines at the Mammogram Factory, where I used to go, didn't hurt my breasts much, and also didn't reveal my cancer until it had reached stage 2. I asked to have a radiologist and not a fellow talk to me about the results. I got a middle-aged woman I'd never seen before. She explained that I had calcifications and they'd been benign in the past, and hadn't changed much, and were probably benign. But she recommended I have another mammo in six months. I told her that when I was first diagnosed, I had a bad experience with the fellow, who hadn't called me when she said she would, and then when she did call, just said, It's positive, and seemed very cold. The radiologist looked in her records to see who that fellow was, said she was now out of state, and that she was sorry. She added that some patients might not even know what positive meant, they might have thought that it meant good news. She said she didn't like having people receive the news over the phone because you don't know where they are, and that it's really bad when you give the news to an elderly woman who's alone. I asked what training the fellows get, and said that they should get better training, and she said the best thing is to give feedback, that's the only way they know if anything's wrong. I guess I should have said something at the time, but there was so much else going on. I was still teary about this. I hated that cold blonde fellow.
And I know that she was nervous, and aloof-seeming because she was nervous, and also seemed defensive, because she wanted to prove she was a Real Doctor while the patients were thinking she wasn't real and bona fide yet. And maybe it didn't help that she was pretty and blonde and maybe all her life had been trying to convince people that she really was smart. I think now I would be able to tell people they had cancer, but I wouldn't have been able to when I was younger. Why should some 25-year-old know how to do it? I think the radiologists make the fellows do it because they don't want to. At a conference in Iowa this spring I heard a med student (widow of a man who died of cancer in his 20s) talk about how her fellow med students would giggle when they were role-playing delivering bad news. And she didn't want to chide them and tell them that it wasn't a laughing matter, she just let it go. I think the radiologists need to train the fellows how to talk to patients. What makes this tricky is that you have to be secure if you're going to address the patient without pretense, and the teaching docs can't teach security, they can only encourage it. If you're secure then you don't have to be absorbed in proving your expertise. You can pay attention to the needs of your patient.
I do want to find out how they're trained to tell patients they have cancer. There's is a humanities center connected with Fancy Hospital, and I know it's well-regarded, but I haven't met any of the people there. I shall.
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