Accept the decisions patients make

asco-logo In an era where health information is freely flowing thanks to the internet and Dr. Google, I’ve come to expect that patients who see me for the first time will have done their homework — about their cancer, treatment options, and yes, even about me. To be frank, it’s not uncommon for patients to mention they’ve watched videos on YouTube or read some of my blogs, or to recite my work history.

I have come to appreciate discussions with such patients; I appreciate the homework they’ve done to learn about their diagnosis, standards of care, and investigational approaches. I feel that I am actually teaching them more effectively about these topics. Ultimately, I think when patients are engaged in their care, these discussions tend to be more thoughtful, particularly when it comes to individualizing therapy as we strive to balance treatment benefits and risks with a patient’s own goals and preferences.

Still, every so often, I run into scenarios that challenge me as a clinician. Such was the case with a patient that stays with me, even years later. Let’s call her Rose*. Rose was a youthful 68-year-old woman who originally presented with uterine bleeding. An exam showed a tumor protruding out of her cervix and a biopsy showed it was consistent with a uterine cancer, grade 2 endometrioid. Typically, a gynecologic oncologist would be pursuing the work-up imaging to evaluate the extent of uterine involvement, to assess for nodal involvement, and to rule out metastatic disease. However, she refused. My colleague had told me of multiple visits held and discussions of how important staging was. Still, she steadfastly refused to proceed with imaging. Hoping to change her mind, he had referred her to me.

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