Biren Siraiya strives to pause and reflect, sometimes midstream,
when he's sharing dispiriting medical information with one of his patients. "Just to slow down
the conversation, even in my own mind," he says. The New Jersey oncologist watches for cues,
verbal and non-verbal. Is the patient making eye contact? What is she doing with her hands?
Does the question she asked reflect what she really wants to know?
This level of sensitivity isn't necessarily innate. Saraiya,
who completed his oncology fellowship last year, says that he tended to focus too much on
chemotherapy regimens and other scientific details until he completed a communication program
for oncologists, called Oncotalk.
"I had my own agenda when I went into the room," says Saraiya,
who works at the Cancer Institute of New Jersey in New Brunswick. "That's all nice, but the patient
may not actually hear what I have to say."
In recent years, medical schools and residency programs
have placed a heightened emphasis on physician communication. Communication skill is one of
the competencies required of residents by the Accreditation Council for Graduate Medical Education.
For oncologists, more than some other specialists, patient communication includes a
recurring theme: the delivery of bad news. Seattle oncologist Anthony Back, Oncotalk's
principal investigator, estimates that one-third of a typical oncologist's day is spent
providing some depressing news: a diagnosis itself, an unsuccessful chemotherapy treatment,
or the transition to hospice care, among other topics.
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