There needs to be sensitivity training on delivering bad news. Not all doctors have the courage, maturity and sensitivity to handle this delivery they are required to make well.

At the same time, the majority of doctors we had for treatment were, although busy, very caring.

Sent by Irene | 9:45 AM ET | 03-07-2007

Hey Leroy and Dr. Tejura,

When I first received my diagnosis, and then after my surgeries while I was still "fuzzy" and my dear husband was still in shock when we were asked by drs and nurses "Do you have any questions?" We were so traumatized that we couldn't form questions. Maybe a few prompts from the experienced cancer specialists to the stunned cancer rookies that "Many people wonder..." or "Some women ask..." It would have helped me immensely to just get my brain started.

Thanks for asking.

Sent by Katie | 9:47 AM ET | 03-07-2007

What you do for a living will become routine for you, but it is never routine to your patients. Please remember that. Make as sure as you can that you're answering your patients' questions in language that laypeople can understand, have them tell you what they think that you just said, allow them to tape record their appointments with you, so that they can listen over again and miss the majority of what you've told them that blew right through them as they worried, were fearful or overwhelmed. Be truthful, but when being truthful, be kind, and acknowledge the pain that hearing hard truth causes. Remember that we're not the breast cancer in 401 or the colon cancer in 543, but spiritual beings, having a very human experience of illness.

Sent by Nancy K. Clark | 9:49 AM ET | 03-07-2007

Leroy:

Within our support group that meets every week, a very frequent subject is that of our physicians. Very high on the complaint list is "lack of compassion."

Compassion 101

Do Doctors take Compassion 101?

Are they taught how to treat us with kindness?

Can Considerate Cancer Care be instilled from without?

Compassion must come from somewhere, but where?

If Doctors do take Compassion 101,

Do they get marks from the teacher?

Are there A students and B students?

And what about the dunce of the class?

Three Doctors knew my Prostate well.

One said, "Call me anytime!"

The second said, "Daytime or nighttime!"

The third said, "Do you realize how many patients I would have to call?"

Should I feel lucky to have had two Doctors with As, and only one with an F?

Sent by Don Winslow | 9:53 AM ET | 03-07-2007

Thank you for being willing to go into this difficult and emotionally challenging area of medicine. You will be more appreciated than you can possibly imagine. Perhaps you could keep in mind that you will see many patients every day... for each of your patients, the time they see you is probably the only thing they're focused on that day and it's likely to be a big deal — they may have been up the night before worrying about the appointment, their work and family may be suffering under the stress, they may not feel well from treatment or stress, they may not "be themselves."

For every patient, even if the treatment is straightforward and the prognosis is good, this is a big deal. Pay attention to each patient as if they were your own loved one and really try to listen to them — always give them several chances to ask questions and express concerns, no matter how minor or "silly." One of my favorite doctors always makes sure I have an opportunity to ask questions, and told me I had as much time as I needed when I came in with pages of questions following my diagnosis. He went through all of them (45!) and if he didn't know or wasn't the right person, he told me so and then arranged appointments with other docs for me so I could get my questions answered before starting treatment. He always calls when he says he will, and treats me with respect and kindness. Another doctor gave me his home number in case I had an emergency. I will remember not only that they treated me, but how, and I rave about them every time I mention them. Thank you for asking us to help you help us better!

Sent by M.J. | 9:55 AM ET | 03-07-2007

Wow. I am sure we are going to open up Pandora's box with this topic! I agree with Leroy in the search for honesty and truthfulness with each encounter, every scan, every visit, every single time!!! I do however understand that they are not always able to help me feel secure in their answers but I would so appreciate a little bit of empathy whether the answers are for the best or the worse. I sometimes feel that my oncologist is too matter of fact and very technical in his delivery and I want him to give me all the facts but in the next moment I wish that he could pass along a little bit of reassurance with a simple gesture such as a pat on my shoulder or a sincere look into my face to let me know he will do his very best! I sometimes feel as just another "cancer" victim in his long list of patients to deal with on any given day. Thank goodness not all of my doctors are so matter of fact. My radiologist is compassionate in every way possible as was my surgeon, even though he clearly was uncomfortable giving bad news !

I guess it all comes down to the individual... doctor and patient. We are all individuals dealing with life and death in our own way... seeking cures...looking for hope. And in the end I still feel as though if I wasn't my own advocate ... it wouldn't happen!

Sent by Marianne Dalton | 9:58 AM ET | 03-07-2007

"One kind word can warm three winter months" ... Japanese Proverb

Sent by Emile | 9:59 AM ET | 03-07-2007

I think the fact that Dr. Tejura is asking the question demonstrates he will be a great doctor. As usual, Leroy, you have outlined well the things that make your doctors outstanding and some of the qualities we all want in our doctors. One thing I'd like to point out to Dr. Tejura is that we are all different. Personally, I want as much information as possible. I will also do my own research and check everything I possibly can. I want to be involved in the decision making process. I want the truth straight up but I know others who don't want that much information. The important point for Dr. Tejura to know is that we are all different, we cope in different ways but each of us is dealing with a disease that will alter our life whether it is a cancer he has cured numerous times or one that is viewed as hopeless. It is a time when we need attention, expertise and recognition of the impact this diagnosis has on us and our support systems.

Sent by Dona | 10:02 AM ET | 03-07-2007

Allow us some control.

Don't be patronising and talk down to me as if I might not understand or am a lesser being.

A little courtesy — asking if they can see something, or do some procedure — goes a long way.

Hear me. Truly listen to my fears and questions whilst trying to see it from my perspective.

Permit me to be scared without dismissing it all. Don't insist I should have moved on and be positive — it's hard enough to "do" cancer without having to smile for everyone as well. You should know, more than most, how hard it all is.

Humour is great. I love smutty humour. Even when things are bad my humour can kick in. But use your own with sensitivity as a laugh at the wrong time or on a sensitive subject can wound.

Please don't make me feel you can't spare time to talk to me and are glancing at your watch. I feel unimportant and a nuisance then.

Try to understand ME. I have my own humour, my own sensitivities, my own experiences. Know I get wound up about stuff but still accept me and don't expect me to be other patients who don't behave like that in front of you. Today my wound bled again — it's been almost 6 weeks from surgery and my natural inclination is towards blind panic at all things. When I spoke to the nurse I needed her to know me and to understand I just want a bit of reassurance and that it's OK for me to be panicky and sometimes need messages repeating as I forget things when I am anxious.

I like it when you know my name and recognize me in other parts of the hospital, so I am not unimportant and forgotten about once I step out of the room.

If I am unable to leave my bed please do not forget to readjust the lighting and return my bed table to how it was before you came in. I feel very annoyed when I am besieged by drs who move everything and sail out leaving me with lights in my eyes and having to call a nurse so I can reach my drink or glasses again.

That's a start...

Sent by JJ | 10:06 AM ET | 03-07-2007

Like Leroy, my doctors have always been good about spending as much time as need to answer my questions. I still find I don't always understand or remember what they say afterward. I would say a written treatment plan would really help. It only needs to be a 1-page summary of the high points of treatment: for radiation: 30 treatments, 5 days a week for six weeks, about 15 minutes per treatment. For chemotherapy (I've had both): 2 hours of ICE chemo on Monday, 24 hour drip on Tuesday, 2 hours on Wed. That way there are fewer surprises and the patient feels a bit more in control. Kudos to Dr. Tejura for reaching out!

Sent by Mark Vollmer | 10:08 AM ET | 03-07-2007

Leroy, My husband, the cancer patient, was a physician and I am a nurse. Because of this, I recently had the rare opportunity to speak to an auditorium full of medical students who were asking me the same questions that Dr. Tejura asked you.

Here's what I told them in a nutshell:

- it's more important to listen than to speak.

- when you do speak, choose your words carefully and deliver them thoughtfully.

- the patient is scanning your body language for clues and clinging to your every word.

- don't ever forget that you have power over peoples lives. What you say, how you say it, what you do, how you do it really matters.

- be honest but never take away hope.

Sent by Marilyn | 10:10 AM ET | 03-07-2007

Dr. Tejura, you must have an honest sense of humility just to ask the question, "What can I do better." Thank you. And I'm sure Leroy's loyal readers will really let you hear it.

In my current battle with brain cancer, I underwent six weeks of radiation. I talk about it at www.ihaveabraintumor.blogspot.com under the headline "Radiation in Tuscany." I didn't have radiation in Tuscany, but my doctor made it, in some ways, feel like that. From what I've heard from others who've undergone radiation, my experience was quite different. Perhaps you can learn something from it. And you can also read about what may be one of the weirdest doctors appointments ever. Sorry for blatant plug. And all my best as you finish your training and move out into the world of patient care.

Sent by Jordis | 10:12 AM ET | 03-07-2007

Dear Dr. Tejura,

I had a wonderful radiation oncologist and what made her wonderful was her gentleness of spirit. She looked me in the eye and I felt like she care about me as an individual. When I was having my radiation treatments, I got quite sick from the combination of the radiation and chemo. I was sick enough that I didn't care that I was sick and too sick to call my oncologist to complain effectively about being sick. Nor did I realize how sick I was and that it was serious. She took things in hand and called for me, with the urgency I lacked. She advocated for me. I am grateful. It was a horrible time for me. I suppose that is the most important part of what she did. She saw me as a whole human being, not just a sick pancreas.

Sent by Stephanie | 10:14 AM ET | 03-07-2007

Be a champion for the patient, even if the news is absolutely the worst. Try to show that you are on the patient's team, even if he or she has little chance of surviving. The attitude of we're in this together can make all the difference... even, or especially, if the outcome is doomed.

I have seen doctors care for friends and family with cancer as if it is just their job and when the news is bad, they are so afraid to give false hope, that they have nothing positive to offer. Try to ignore the fear and champion hope. Please.

Sent by Crow | 10:16 AM ET | 03-07-2007

Advice to doctors:

DO SOMETHING ABOUT THE MEDICAL PRIVICY ACT! When I want information on my 86-year old father if he is in the hospital, I should be able to get it. Why can't there be a password or code, just like the computer, that allows me access to his medical information? I know that he would agree to this. This medical privacy act is absolutely RIDICULOUS!!!! Something needs to be done!

1. Probe. Ask questions. Get a good family history. Take measures to do preventative medicine, don't just fix what hurts.

2. Explain what is going on. Explain side effects, long-term effects.

3. Take time with the patient (Leroy, you are lucky. Nowadays, too many doctors are in such a hurry!)

4. Follow up on us. Find out how we are doing. Get to know us. So often, there is a disconnect with the doctor and the patient. We need to have some trust in you. One way is to know that you are concerned. (Whatever happened to the doctor with his little black bag? My father had one and made house calls)

5. Make room for us in your schedule. Waiting months for an appointment is absurd.

Medicine has become too much of a cut and dry profession. The rapport that one once had with his/her doctor is no longer there. If we have a medical problem, we first get the receptionist who then gives us to an answering machine where we leave a message and hopefully the advice nurse will get back with us. We don't even talk to the doctor and if we do, it may not be until days or even months later. Direct contact with the doctor is getting to be more remote. Why can't the doctor call us back?

Leroy, I could go on but I have to run to work. You have opened a can of worms and thank you for doing so!

Sent by Laurie | 11:10 AM ET | 03-07-2007

The docs have been great, but I have some concern about the lab techs who run the tests. My wife is always nervous when she gets her scans (she is stage four breast cancer) and when the techs make faces or whisper to each other dramatically, she starts drawing conclusions. Naturally they can't tell her anything. I know it is hard, but they need to think about poker faces.

Sent by Steve | 11:12 AM ET | 03-07-2007

One thing that always amazes me about my visits to my Oncologist is that I feel more confident, more calm and more ready to fight the fight than when I went into his office. Surgeons, I have found, have a tendency to be more clinical in their approach to your disease than Oncologists and it is with him (my oncologist) that I get my warm feelings that 'we are in this together.' One of his favorite sayings is "we'll get this figured out" and I truly believe him.

Compassion and understanding are the keys.

Sent by Geneva | 11:17 AM ET | 03-07-2007

Dr. Tejura,

Get as many different opinions as you can from your "fellow radiologists" for a patient. At MDA in Houston, they had a whole team of radiologists looking for a way to apply radiation around the left eye on the left side of my face without damaging the optic nerve. Thanks to the input of many, they were able to radiate around the optic nerve without damaging it. It took them 3 days to figure out a feasible treatment but it worked. It was a miracle in my opinion.

Treat patients with a little humanity and dignity not like they are a medical record number on a chart hanging outside an exam room. Don't keep your patients waiting in the waiting area for two hours like they do me at MDA. At least send someone out to explain why their wait is taking so long. It's called "consideration."

Thanks!

Sent by Larry Hamm | 11:19 AM ET | 03-07-2007

Dear Dr. Tejura, First of all thank you for asking! I would have appreciated a more uplifting positive environment for treatments. Most were like dungeons — very depressing with white walls and cold black or brown chairs. How about some colorful paint, motivational posters & good aromas. Yes, this is a very serious time, but we are there because we are trying to HEAL our bodies! Visual stimulation really helps a person stay positive. Also, I really needed my Oncologist to be the Cancer Specialist who treats the WHOLE person with cancer, giving information or advice on nutrition, exercise, massage... Not just the doctor who zaps you with radiation or administers the Chemo.

Sent by Susan Penrod | 11:25 AM ET | 03-07-2007

Oh, boy, do I have an opinion on this one! My present doctors (oncologist and radiation oncologist) are wonderful, but my previous oncologist and my surgeon? I think they both could have used a lot more training in human relations!

Here's what is most important to me:

1. Be honest. Admit what you know and don't know.

2. Demonstrate that you are staying abreast of all the very latest research and studies. Include me in all decision-making and share your thought processes (how you arrived at a recommendation or opinion).

3. Show some sensitivity!! Remember the Golden Rule? How would you want a fellow doctor to share bad news with your wife or mother? My surgeon told me the cancer was invasive as I was lying flat on my back, as he was jerking out a drain! I guess that was easier than looking me in the eyes, but it was inhumane. My first oncologist chuckled nervously and cracked a couple of jokes as he told me my cancer was "OOOhhh — Stage 3... or maybe even Stage 4!" Be compassionate. I understand that when a lot of your patients end up dying, it would be easier for you to remain distant and not form real relationships with them. IT's natural to be self-protective. Don't do that! Remember their names. Look in their eyes. Laugh together, cry together (well, maybe you shouldn't cry, but a gentle hand on a shoulder wouldn't hurt occasionally). As the punchline in one of the books I used to read to my kids said, "Care, Pierre!"

4. Even though you are very busy, make time if I say I need a longer conversation than the usual five minutes. Then really listen to my questions or opinions. Don't automatically discount information I may have gleaned from the Internet or a newspaper or my brother-in-law, the doctor. I respect your training and superior knowledge, but lets work as a team, keeping our minds open to all possibilities.

Sent by Doris | 11:39 AM ET | 03-07-2007

What I love about my radiation oncologist is his aura of confidence and humor. There is no need for everyone to approach me like they are walking on eggshells or for them to drag a dark cloud around. While under his care, I had a recurrence in the skin. Everyone was fussing about it and very concerned. He walked in and announced, "Who's causing all the trouble??" It was great.

What I love about my oncologist is she is 100% on my team. She works towards my goals, she doesn't decide for me whether we should fight hard or give up, she lets me call the shots. If I want to ask hard questions, she has the straight answers. If I want to focus on living, she doesn't feel the need to make me understand my prognosis. There is room for both living and fighting. I can chat about what I'm working on in my riding lessons or what happens when it goes to my lungs. I may have to wait for my appointment but I get her undivided attention during my appointment and never feel rushed out of the room.

My biggest fear when I was diagnosed was that I would hear "I'm sorry, there's nothing I can do for you." I don't think she will ever utter those words.

Sent by Karen | 12:33 PM ET | 03-07-2007

You've said most of what I'd say. Compassion, humor, honesty and time. Professional boundaries are a little more blurred with this cancer thing. Once as an appointment ended, my oncologist and I hugged each other. I thanked her and she commented, "This one is for me..." Remember that you are human also and that the giving can go both ways.

Thanks for asking, Dr. Tejura!

Sent by Betsey Kuzia | 12:38 PM ET | 03-07-2007

Dr. Tejura

As you are in radiation oncology, please always be on the lookout to improve that horrible mask people are made to wear when their heads are receiving radiation treatments. When my husband had to wear it, they really worked with him, they even cut a hole in the nose so he could breathe while he was clamped down to the table. A grown man crying like a baby, on every drug imaginable, but still brought him to his knees. He called it torture.

Sent by A wife | 1:10 PM ET | 03-07-2007

Wow!! What a question! I guess the best way to answer is to say thanks for asking and how would you like to be treated as a cancer patient? A couple of comments for one who I assume is uninitiated in the cancer patient world:

Don't be satisfied with one-word answers especially to the simplest of questions like how are you feeling.

Do look up from your desk or clipboard into my eyes. You'll be surprised how much can be seen there.

Avoid the data dump, forget the fancy pamphlets and tell me what it all means. I can read but I cannot interpret.

When I start to cry or tear up, I'm not looking for a tissue, I am looking for hope. Give it to me.

Remember, you are probably the only one I really want to talk about cancer with and the only one I'm listening to.

It's a long road we have begun to travel together, let's make the effort to know one another better.

Again, thanks for asking.

Sent by Jessie | 1:13 PM ET | 03-07-2007

Dr.Tejura, please do not do as my thyroid cancer specialist did but follow what my thyroid cancer surgeon did.

My thyroid cancer surgeon was honest in delivering "the bad news." His exact words: "this is not what we were hoping to find." He then gave me his home phone # with the best time to call, the address of the local thyroid cancer support group, told me not to believe everything I read on the Internet and to please call him with any questions. I was pretty much in shock over my news but do remember these kind and intelligent words.

Now from the thyroid cancer specialist:

"You have nothing going for you" were his words as he held up his right hand and began to touch each finger to emphasize each problem: you are too old, your tumor was too big, etc.

To this day (3 years later) I hear both these doctors speaking. One gave me hope and the other took it away in a matter of days.

I believe you will be like the thyroid surgeon.

Added information: Both doctors graduated #1 in their medical school class from an Ivy League school. I like to think that one of the doctors cut class the week they were teaching patient/doctor relationships!

Sent by Elizabeth | 1:16 PM ET | 03-07-2007

After reading the comments posted, I sometimes wonder if people realize that doctors are just human, with all the failings that we all have. We sometimes expect them to be superhuman. That said, I think one of the most important things to remember, is to admit your mistakes openly. In our litigious society, honesty about mistakes goes a long way in preventing malpractice litigation. Four physicians failed to diagnose leukemia in our son within one month of his catastrophic diagnosis. Yet, our pediatrician stepped up to the plate, offered us her compassion, her home phone number, and was one of the first to visit in the hospital. I will always be grateful for her compassion.

Sent by Denise | 1:17 PM ET | 03-07-2007

One of the best things my son's oncologist did was put together a folder of all the information about the type of cancer and the treatment. She also included the types of drug to be used, pronunciation of the drug, side effects, etc. My husband and I were in shock the first few days and it was impossible for us to remember what the doctors told us. Once reality finally settled in, the folder provided important information. It was also great that the nurses included a monthly schedule of the treatments, so that we can plan our life a little (and feel that we are somewhat in control of our lives.)

I am not sure if doctors always have choices in the nurses they work with, but try to have compassionate nurses. We spent most of our treatment time with the nurses. Our nurses were there to soothe our son when my husband and I were completely distraught. They held my nervous hands when I was learning how to change the dressing around my sons Broviac line and when I was so nervous that I couldn't understand simple instructions on how to program the IV pump, they were there for me. So please keep in mind, the nurses are as important as the doctors.

Sent by Grace | 5:46 PM ET | 03-07-2007

Dr. Tejura,

If I am your patient, I want to be treated with the same care you would give to your favorite family member. Set aside the fact that we are strangers and keep in mind we are both human beings. The cancer will hurt my body as will the treatment. I don't need to have my feelings hurt as well. Please don't hide behind your credentials. Please tell me the truth, even if it hurts you to deliver bad news. Let me see that it bothers you because that will mean you are with me in the way I need you to be. That kind of doctoring is hard to do. Be sure you have a place and/or person you can seek out to take care of your own pain. Otherwise you will become insensitive... or go into some other branch of medicine! It is wonderful that you are concerned about this issue. Best of everything to you!

Sent by Diana Kitch | 5:47 PM ET | 03-07-2007

Be honest is great advice, be clear is another piece of advice. Many times I have I seen a Doctor say to a family "s/he's very sick" the family may be thinking treatable (bad cold) while the Doctor is thinking actively dying.

If there is nothing else to be done say so clearly. I have sat with many families trying to make sense of someone's death because the Doctor was not clear, call the chaplain or a social worker to help you explain this to patients.

Do not be afraid to refer to hospice or palliative care. Think what a last week is like in the hospital versus hospice. If the patient dies in the ambulance on the way to Hospice you waited too long to make the referral. Think about quality of life not just how long you can stretch out the dying. If chemo is not going to provide any hope, why subject patients to it in the last days.

Do not be afraid of the dying. It is grace to share those moments with patients and families. I have seen some beautiful moments around deaths when everyone is aware of what is happening, sometimes you give us false hope and we fight too long, making the end miserable for everyone. Living and dying are processes; learn to cope with them so you can help patients on the journey.

Do not be afraid of your feelings. My surgeon had tears in his eyes when he told me my tumors were malignant, I knew he got it, I knew he was caring for me the best way he could, I was able to completely trust him to care for me. Make sure your staff is compassionate also, not all staff are meant to be in oncology. Move them on if they are not able to be there for patients. Cancer is bad enough without bitchy nurses.

Let us see your human side. Then make sure you have someone to talk to, to help you cope with what you see daily. Then we can be partners on this journey. You will get more than you give.

Sent by Elizabeth | 5:49 PM ET | 03-07-2007

I agree with Irene. Our doctors are very busy and yet very caring. They have been sensitive to our needs. Maybe we are just lucky to have such caring, concerned and polite bed side mannered Doctors. I personally want to thank Dr. David Korones (Strong Memorial Hospital) and our internist Dr. Michael Dobmeier both from Rochester, New York.

Sent by Gail Hunsberger | 5:52 PM ET | 03-07-2007

"Human dignity" is one of the core values of the college I am attending for Radiologic Technology. The students sit through lectures at length on this topic and the time is not wasted. Some of us are going onto programs in radiation therapy, nuclear medicine, etc where I hope these subjects are integral parts of the program. We are taught how to hold a patients gown closed, how to address all the cultural differences, how to hold the hand of a frightened patient, how to dry the eyes of a crying child. We've taken on the role as patients by being the passenger on a stretcher or in a wheelchair. We practice our positioning on each other, in turn getting a feel of what it is like to poked with needles, cold hands and questions. Our instructors reinforce the belief there can never be too much emphasis on human dignity.

Let me tell you about my doctor. He is something to be admired and imitated. My first visit began as nothing short of terrifying. I knew my cancer was invasive, but how far has it gotten? Will I be able to plan for more than the moment? Surgery? Chemo? Radiation? Nothing because I am a lost cause? Before he even examined me physically, he took my hand, held it to his heart and said, "I am going to take good care of you and we are going to get rid of this." And we did. Just that little bit did more to change the tears of fear into tears of relief. Even now, two years later, when I go to for my 4-month visit, after the exam is over and the nurse leaves the room, he sits and talks to me. This is my opportunity to ask him anything and everything. I am given this slice of heaven at every appointment. I know, I am not the only patient on his hit parade but this is afforded to each and everyone of us. So as a patient, I know he may be running late (usually 45 min.), but its time well spent by making sure all of his patients are well cared for physically, mentally and emotionally.

Dr. Tejura, I hope and pray I will be as caring as you are with your patients. As a cancer patient, the one thing I can impart on you is to treat them as you want to be treated and never, ever let the line of communication you work so hard to establish with them close.

Sent by Teri Thomas | 5:56 PM ET | 03-07-2007

It sounds like we want our doctors to be all things, which we probably do in this situation, but I think doctors really need to take their cues from their patients. I had a bilateral mastectomy and reconstruction this fall and my surgeon and my plastic surgeon were totally different in how they worked with me.

I'm one of those people who want as much information as possible. I want to see the X-rays for myself, I want to know how the surgery is done and I want to know about any potential problems. I want to be an active participant in the process and not just show up for surgery that day. My surgeon seemed to grasp that and answered my questions thoroughly and honestly and spent as much time with me as I wanted. He drew me diagrams and walked me through my x-rays. He put the decisions in my hands and gave me enough information that I felt confident in making those decisions. He wasn't a "warm and fuzzy" kind of doctor, but he was always professional, respectful, patient, and kind. I got the feeling that he saw me as a person and not a procedure. I felt like I was in capable and caring hands and trusted him completely.

My plastic surgeon was always busy, always late for appointments and always raced through my appointments. He'd be telling me that everything looked great before he'd even glanced at me. I felt completely patronized. I had to ask questions repeatedly and stop him from leaving the room before I was happy with his answers. I felt like he was just patting me on the head and saying, "There, there, I'll take care of everything" when that was NOT how I wanted to be treated. We just didn't mesh at all and I had to be really assertive to get the information I wanted.

I've talked to other patients who were the complete opposite in how they approached treatment. They didn't want any more information than necessary and wanted their doctors to make the decisions for them rather than with them. That made them feel much more comfortable with the whole process. Too much information just scared them.

No doctor will be a perfect fit for every patient, but being willing to adjust your "style" in accordance with the patients "style" would help tremendously. We're all individuals and cope with our treatments in our way.

Thank you for listening and good luck in your practice. Thank you for asking this question.

Sent by K. Ives | 6:00 PM ET | 03-07-2007

I was very fortunate to have been allowed to attend my sister's oncology appointments. What I particularly liked about her doctor was his ability to make her feel comfortable, whether it was the way he delivered unwelcomed news or his giving a hug before we left.

We never felt hurried on any of our visits and questions were always welcomed either in his office or via email.

My emails were always responded to in a prompt manner.

During the last phase of her life, he returned my anxious phone calls within hours. It was like getting a hug through the phone line when talking to him.

Her doctor was not only committed to her care, but also her family's emotional care. I guess cancer does that.

Sent by Anita | 6:03 PM ET | 03-07-2007

Dr. Tejura,

Please, please don't lose the open-mindedness and humility that enabled you to ask such a question.

I've had two major problems with my doctors (certainly not all of them as a matter of fact the radiation oncs were the best!) One problem is their total inaccessibility unless you're physically in their office (return a phone call????? HA!) and the fact that unless you can come up with your questions and concerns in about 5 minutes, its over. My oncologist never sits down and is poised for flight as soon as he walks in.

The second is doctors who lend a negative cast given to everything. How many times must I be reminded of the bad, bad odds confronting me? Honesty is one thing, but doctors aren't God and I see no point in throwing shovels-full of dirt on me just yet. Last week I had to make some rounds of a number of doctors with my husband in tow and the number of negative comments was overwhelming to us both. These doctors not only hold no hope themselves, they don't seem to want you to hang onto any of it either. Words are so powerful to a vulnerable person and opinions can be so self-fulfilling. Please always be so careful how you phrase things. Never forget the power you have and the gift you can give your patients by being sympathetic and caring and by delivering honest news without destroying hope. There is always hope.

Sent by Ruth Crawford | 6:06 PM ET | 03-07-2007

I have thought about this question so much.

For me, the #1 thing that got me through my diagnosis and treatment was my doctors all (from OBGYN to oncologist to radiation oncologist) seemed truly sorry that this was happening to me. They gave me all the information I wanted and needed and looked me in the eye when I was faltering.

When my OB/GYN told me the very unexpected news, she teared up and hugged me and told me she would be there even when I had to see other doctors.

That meant so much to me.

Sent by Robin Smith | 6:07 PM ET | 03-07-2007

My oncologist is unique because he takes time to talk about something OTHER THAN my cancer. I was telling him that I was teaching the Diary of Anne Frank in my 8th grade English class when he asked what I was up to in recent days. He then shared with me that his father was a Holocaust Survivor and asked if I read Night by Eli Weisel (which I later did read). All this took less than 8 minutes, but was so meaningful. Then we talked about my cancer. I have always felt my oncologist was more than a doctor and that he saw me as more than a patient. We are people to each other.

I am so grateful he takes time to do a bit of chitchat.

Sent by Susan Paprocki | 6:11 PM ET | 03-07-2007

I agree with Leroy and others that it is most important to be honest and straight forward. And timely — I want to know the results of my scans/tests/etc as soon as you can possibly spare a moment. I've even had doctors email me with results if they don't have time to call. Personally, I'm fine with that as Id rather know what's going on than wait a few hours for the doctor to have time to call.

And give hope. I am 34 with stage 3 colon cancer and I am always buoyed when my oncologist says, "you'll be fine." I know he can't know that for sure, but it sure helps to hear it.

Obviously you have found this blog and hopefully you are reading others. It's a great way to get some glimmer of understanding of something that is almost impossible to grasp unless you've been through it. As a med school dropout, I know that the training for this is minimal at best. Rachel Remen runs a great week-long program near San Francisco to train doctors in this neglected art.

Feel free to read my blog:

shortcolon.blogspot.com

(That goes for all you others out there in Leroy's cyberworld as well. Read on!)

Sent by Megan | 6:12 PM ET | 03-07-2007

For the future Radio Oncologist,

I was diagnosed with breast cancer two years ago and went through the full treatment — surgery, chemo and radiation. By the time I hit the radiation part I wasn't scared of cancer anymore, but rather curious about how it grows, how long it takes before a tumor reaches a size big enough to being detected, how does the machine work and where in the cellcycle does radiation attack the cells and many more questions. My Radiation doctor explained and showed me everything!!!!

I also appreciated his humor, yes humor!

Humor might not be appropriate, if you are the first one to tell a patient that she or he has cancer.

I utterly enjoyed and looked forward to see my Radiologist, because he could give me the feeling you do not have to stop enjoying life, just because you have cancer.

In short — don't hesitate to smile at your patients - it'll certainly help make them feel better.

Sent by Stefanie Ritter | 6:15 PM ET | 03-07-2007

I agree that the oncologist, like no other doctor, should be the person you trust and the person you go to for information. And how this doctor treats you and how you interact with him/her can be a source of support, strength and comfort. I don't know how my oncologist does it... day after day. And so many of the patients die despite his best effort. I guess he gets a lot of comfort from those he saves. Thank you Leroy for all you have given and continue to give to those of us who deal with cancer.

Sent by Helene Weingarten | 6:16 PM ET | 03-07-2007

Dear Leroy and Dr. Tejura,

One large thing not mentioned by others — Please try to imagine what you are sending your patients home to. By this I mean that not all patients have supportive families who are physically and emotionally available to provide transportation to treatments, food, a home, a clean bed. Many older homes have no bathroom on the main floor, and people who are debilitated have to spend the whole day upstairs, without access to the main part of the house. So be sure you refer early to Home Health Nursing services, social work, local services to the aging, Cancer societies. Pay attention when a social worker or nurse asks you to sign something for a patient or family — it may make the difference between getting the best care you can give, getting substandard care due to various social/physical obstructions, or even no care at all. Be sure there is someone in your practice who can make a house call, or at least call the patient if they don't show up when expected. A good Nurse Practitioner will extend your reach by at least 100%!

Leroy, I read your blog regularly, and continue to pray for you.

Sent by Rachel Carnahan, RN | 7:36 PM ET | 03-07-2007

My doctor always gives me a hug before I leave. And sometimes she also gives my husband a hug. That hug is worth a thousand words. She cares...

Sent by Mary Scruggs | 7:37 PM ET | 03-07-2007

Dear Doctor,

Your question is so honest, and so will my answer be. I am a registered nurse, and I have had a child in the hospital with a chronic rare disease for months at a time. The best thing you can do to remain a good physician is to surround yourself with people in your life who will keep you grounded. I asked a physician once who was treating my daughter if she had a minute to answer a question. She sighed, looked at her watch and said sternly "One minute!"

Medical students are so alive with possibility and residents are a little cocky, but when you see many doctors who are 2-3 years out, they are shrouded in arrogance. Everyone obeys them, and families fear them, but NO ONE respects them. Arrogance is the disease infecting physicians in this country. Guard against it and listen to your families. If you see a woman in rumpled clothes and a bad haircut sitting by the bedside of a family member, remember that it could be your mother. How would you want another physician to care for your mother? You will obviously do well, as you are seeking ways to improve. Stay grounded my friend and good luck to you. We need more wonderful physicians.

Sent by Therese | 7:39 PM ET | 03-07-2007

Thanks so much for asking us. What a wonderful doctor this man has the potential to be! I am impressed that he is humble enough to ask what we think.

I would like to say: please remember that though statistics have there place when it comes to talking to people about survival, the benefits of one drug vs. another, how long a certain drug might prolong survival, "we are each a study of one, "and statistics actually are just plain wrong sometimes. If I believed for one minute what the books told me seven years ago about the length my life would be with metastasis in my liver due to breast cancer, I would have died of fear itself. We are all a study of one and that's SO very important to remind people. I truthfully know more people with cancer who defy the statistics than who fulfill them.

And there is this: Never ever ever tell a first time patient over the phone that her/his biopsy was shown to be malignant as my doctor told me in 2000.

Thanks so much.

Sent by Nancy O. | 9:42 AM ET | 03-08-2007

Smile!

Sent by Gregg | 9:43 AM ET | 03-08-2007

Leroy — I'm only a mother of a kid with cancer, but what I love about her docs is that they are just people like you and I and they act like just people — very smart people, mind you, (and on all the important national committees and such) but just people. They are not pretentious and they don't pretend to have all the answers — cancer's not that exact a science. They are very, very smart and I respect them tremendously, but ultimately, she's my kid, and I will seriously consider all they say, and then make the best choice I can for MY kid.

So I need my kid's docs not to make it a problem that I have a brain and will be utilizing it at all times — and they never give me the impression that this is a problem for them. I LOVE them dearly for this — to be treated like an intelligent human being. And I LOVE that they obviously LOVE my kid and all their kid patients — they let it show that they are totally invested in helping each kid and their family to the best of their ability.

So to all you new docs — be REAL and don't get all big on yourselves because you got through medical school. Cancer patients are mostly well-studied, bright individuals — they HAVE to be. BE REAL, and KIND and COMPASSIONATE and LISTEN — then you will take all that training and use it well — and for that I THANK YOU.

Sent by Alice Williams | 9:50 AM ET | 03-08-2007

During the early visits and consultations with patients, be willing to admit that radiation may not be the best choice if that is the case. Too many times, doctors think their method of treatment is best. Surgeons want to operate, radiation oncologists want to use radiation and medical oncologists want to use chemotherapy. Try to provide the patient with information so that he can make an educated treatment plan with the specialists.

Sent by Jim Bloom | 10:32 AM ET | 03-08-2007

I echo the comments of others, including the need for knowledge, humanity, compassion, and especially hope. If you have to give bad news, also provide a plan of attack at the same time.

On a more practical note, one thing I really valued was my doctor's equally wonderful nurse, who returned phone calls PROMPTLY. This is invaluable to patients who are trying to cope with an out of control world.

Sent by LDP | 10:33 AM ET | 03-08-2007

A great many folks have noted that compassion is a vital part of an oncologist's medical kit. Compassion is not something that is learned once and thereafter always on tap, but a reservoir that can occasionally run low. As you might suggest to future patients counsel from clergy or social workers, don't neglect your own needs — there is only so much energy you will be able to spend supporting those in your care before you will be drained yourself.

Sent by Bill Hensel | 10:35 AM ET | 03-08-2007

I am 38 years old was diagnosed with stage 4 ovarian cancer. My oncologist was a cancer survivor, himself. This made a world of a difference in my recovery. Everyone other oncologist wrote me off. My oncologist taught me that cancer is a mental, physical and spiritual disease. Recovery, too, is mental, physical and spritual. Healing for me from this disease was not all about the chemo, I had 12 rounds. It was about seeking spirituality, changing my attitudes and most of all really believing that I was not going to give my power away to cancer. Suggestion to the oncologist, read love, medicine and miracles by Dr. Bernie S. Siegel. This book really told my story. I did not become a statistic in the books... my case is going to be featured in a reputable medical journal. Future oncologist, please do not treat your cancer patients like another car in the car wash.

Sent by Sumathi | 10:38 AM ET | 03-08-2007

Dr. Tejura: To the above I can only add the advice that was emphasized to us in massage school: "TAKE GOOD CARE OF YOURSELF, SO THAT YOU CAN TAKE GOOD CARE OF OTHERS."

Make time to do those things that keep your body, mind and spirit healthy and joyful, even though it is difficult to do so with the huge pressures of your work. Thanks for asking. Good luck and wishes for many blessings.

Sent by Anne C. | 10:40 AM ET | 03-08-2007

Hope. Give hope. Even if it is 1%. Don't take it away from us. If at all possible. I want hope. Compassion.

Sent by Janis | 10:41 AM ET | 03-08-2007

The most amazing comment from a doctor was said to my friend by her plastic surgeon recently. After a mastectomy, which of course made this 37-year-old woman very sad, when she visited his office, he told her, "You look beautiful." Wow. She will never forget that (and neither will I).

Sent by Ann | 10:42 AM ET | 03-08-2007

Dear Leroy, I have cancer and have had such horrible reactions to the chemo, the doctor cannot continue the chemo! Just wanted to tell the young doctor to yes, spend more time with your patients. We need the comfort to know that you care! Listen to our questions, and please no communication phone pager that you are dealing with other patients as well as the one sitting in front of you. We may only have a few days weeks months left on the earth make us feel special!!!! Thanks, love your blog Leroy I will be 58 this month and hope to live another ten years, at least!!! We all have hope!!! Smile love and peace to all!!!

Sent by Ann | 10:44 AM ET | 03-08-2007

Leroy, may I recommend a wonderful book by a young transplant surgeon Pauline Chen, which talks about the training docs need and how she learned to deal with patients in a much more compassionate and humane manner — the book is called Final Exam.

Sent by Margie Siegel | 12:59 PM ET | 03-08-2007

I have been in treatment for lymphoma for the past 2 years, and if it weren't for the knowledge and support of my healthcare team — dealing with cancer would be an even greater challenge. What impressed me from the start about my doctor has been shared by many on this site — being honest and treating patients as the individuals that they truly are. It is important to know that there is the physical side with treatment, but equally important is the emotional side. My doctor listens to me and imparts information in a way I understand. He has patience to hear my many questions—he walks me to the desk after every appointment to make sure I have everything scheduled before I go. He has even made sure I had some of my medications (samples) that were very expensive for me in terms of copays. He knows my family and answers their questions—or returns my calls personally if there are times I need help in between appointments. Good luck on your professional journey, I hope you find this information helpful.

Sent by J. | 1:32 PM ET | 03-08-2007

I applaud Dr. Tejura for asking the question and caring about what kind of doctor he will be. I have been to 3 oncologists in different cities. My biggest complaint is the way they are so nonchalant in their telling me the bad news. I understand totally that I have stage IV ovarian that is aggressive and may not be responding to the chemo. But I am also a Christian who believes that my God can heal. I also believe that your attitude and drive and nutrition can overcome many things. Being a totally healthy 50-year-old with two very small children before my diagnosis makes me have to believe that I can also aid in my cancer fight. But being told that I will never go into remission takes away all my hope. And you have to have some hope. If they would just say to me that there are people out there working on cancer treatments and cures everyday, and that they will help to keep me living as long as possible, would be priceless to my psyche. But when they are so direct that they offer no hope, then it takes me awhile to pull myself back up. Instead of letting them put a picture of me in their file, I made them put a picture of my young daughters to remind them that I am a fighting to be there for them.

I remember seeing on the Evening News where an oncological surgeon from John Hopkins is going around the country doing seminars about bedside manners and how best to deliver bad news to patients. She started it AFTER she was diagnosed with cancer herself.

Dr. Tejuro sounds like he will be a wonderful and compassionate doctor who will remember to offer some hope to his patients.

I would be interested in a discussion on if others have found eating differently and/or taking vitamins and supplements and exercise have affected their cancers.

God Bless.

Sent by Denee Frazer | 1:46 PM ET | 03-08-2007

A few days after my surgery for stage 4 colon cancer, one of the doctors from the surgeons group, who happened to be on call that night, came into my room to discuss the results of my surgery and tests. At the time, there were a few visitors in my room from my church. The doctor walked in and proceeded to go over the results, which were not good. He never asked if I minded the others staying in the room while this was being discussed. He told me the news and then left with a remark something to the extent of "Boy, you sure do have a lot of problems for someone your age."

Needless to say, and thank God, I never saw this doctor again, but I did share this with my other regular doctor. So, for some of you docs out there, be a little more sensitive to the patients feelings, okay? And, be aware of their surroundings when discussing such sensitive issues that they may not want other people to hear.

Peace.

Sent by Lisa Majors | 3:34 PM ET | 03-08-2007

My radiologist wasn't always the best at knowing what to say (looking at my purple, blistered underarm he asked "Does it hurt?" and "I've seen worse") but he took very good care of me. He managed three different fields without touching my heart or lungs. The burn was a surprise because my skin had handled it all so well up to that time. My plastic surgeon is happy. He is the head of the radiation-oncology department and he had the office running so smooth. They treat 60 patients a day, and through 33 treatments I never waited more than a few minutes.

My best doctor experience through this was with my plastic surgeon. I developed a hematoma after my mastectomy. He had us meet at his office that Saturday, decided I need surgery, made the arrangements at the hospital, followed us to the hospital, wheeled me to admissions, admitted me (they lost the information in the 15 minutes it took to get there), and wheeled me to my room. The operating rooms got jammed up and we didn't get started until after 10:00pm. He never complained a bit. He noticed I had a low blood sugar on admission and went back through old hospital records from years ago looking at my previous blood sugar. What a doctor!

Sent by Marcia | 5:09 PM ET | 03-08-2007

The best experience I have ever had with my current doctor is her ability to have a deep well of empathy for patients. She hugs me, tells me she's happy to see me doing better, and tells me I can stay in her office as long as I need to. That kind of treatment is so rare these days. In the same office, another doctor exemplifies what bothers me the most: this doctor doesn't look at me when I explain what my problems are, just staring at her notes while I talk. She throws a medicine at me without discussing it. Then she's off the next patient. I always end up feeling rushed, unimportant, and a nuisance with her. I'm nervous with this kind of treatment, feeling like she is doing me a favor, and I will forget all the questions I wanted to ask.

Sent by Liz | 8:08 PM ET | 03-08-2007

Never, never take away a patient's hope. When I was diagnosed, at age 49, with stage 4 colon cancer the surgeon told me and my family I would be dead in 18 months. He continued to insist that I would be dead even when the oncologist and radiation oncologist told me that we could and would fight the cancer. I will never forgive that surgeon for trying to rob me of the only thing I could hold on to, my hope. By the way, it has been 27 months and right now I am cancer free!

Sent by Jean Balough | 8:10 PM ET | 03-08-2007

I just read each letter. How I wish that these could all be HEARD and/or READ by oncologists everywhere. So many are missing the boat (named HUMANITY.) Our lives are in their hands, and how they interact with us obviously matters hugely. I wish NPR would do a special broadcast on oncologists spinning off from, and using all these comments.

Thank you !

Sent by Nancy O. | 9:54 PM ET | 03-08-2007

As others have made abundantly clear, hope is perhaps the most important thing a doctor can give or take away. I urge you to read The Anatomy of Hope: How People Prevail in the Face of Illness by Jerome Groopman if you haven't done so already. After I was diagnosed with stage III breast cancer, this book was a comfort and an inspiration. Hope is indeed the thing with feathers!

Sent by Jeanmarie | 12:11 PM ET | 03-09-2007

Leroy,

I have emailed this blog to the Program Chair at the college I attend. There is no better way to get across to the students, along with me, who will be invading the hospitals and clinics across the country that will be treating you, what is important to the patient.

There is big medicine on this webpage.

Thank you Leroy :o)

Sent by Teri Thomas | 12:12 PM ET | 03-09-2007

I hope maybe this can be posted even though its 2 days late. The one thing I would add to all the advice above is to not pull away from your patient when they have unexpected problems or don't recover as you think/hope they should.

My radiation oncologist was one of the first ones to hear I was having problems swallowing after treatment, and he didn't do anything proactive about it but told me just to wait and things would get better, after which it seemed my appointments with him were even shorter and more rushed. It wasn't until I told my medical oncologist that a swallowing test was scheduled.

I have had many of the worst-case complications following my radiation treatment and I swear I could see the look of disappointment on this radiation doctors face when some of these first became evident (and the sound of relief in his voice when he told me he didn't need to see me again, additional visits would be handled by my other doctors).

Doctors may not realize how much we as patients not only want to get well quickly, but want to make them happy — be the good model patient — and how badly we can be made to feel when complications that are unusual arise and our doctors seem disappointed and appear to take a step back instead of being hope — giving and becoming engaged in the quest to solve the complication.

Sent by N.R. | 1:06 PM ET | 03-09-2007

Dr. Tejura,

Remember you, too, will feel the hurt of the patients and families you treat. Over time, it is easy to become numb to protect yourself from so much pain.

Compassion fatigue is real. To each and every patient, their case is one of the most important things in their lives and their contact with you can determine how they face the following moments, days, weeks, or years. For you, you will see many people in a day...you will find you must develop a kindness and a compassion that doesn't drown you in its weight but allows you to express sincere feeling.

With every contact you need to rejoice in the beauty of life. You need to remind yourself of how precious each day is and how much your loved ones mean to you. You need to take care of yourself. Find what you need to de-stress, unwind, and recharge your spirit after days filled with giving. By caring for yourself you will be able to care more effectively for your patients.

And, of course, all of the things mentioned in these blogs are priceless. Listen. Keep asking what you need to do to change and grow. Have a place where your patients can leave comments or concerns and read the answers...maybe anonymously since some people may fear pissing off their oncologist. When you find it is impossible to offer that follow up phone call or extra thoughtful gesture, such as remembering a birthday or special anniversary, be sure to have a compassionate staff member who is "genius" at caring at keeping up with such things. But, be careful not to delegate your own compassion.

I have been in a helping profession for many years and when I go in to see my clients I tell myself that for this moment, for this hour, this person is the most important person I see.

Best wishes for a meaningful career.

Sent by Sandi Li | 1:09 PM ET | 03-09-2007

Dear Dr. Krupali Tejura,

I applaud your quest for the intangible. I mean besides the usual be kind, compassionate, honest, and all the other stuff that all these other wonderful people have posted before me, here is something that I don't think anyone has mentioned.

My girlfriend died of lung cancer 6 months ago and I constantly read this blog because I think it is good therapy for me in dealing with my loss. I was the caregiver for her so I have another perspective on things.

Make sure we (the caregivers) also understand what is going on. Melody and I would go to almost every appointment together. I was the other set of ears for her, the note-taker...etc. When making rounds at ungodly early hours in the morning, make sure the patient (and the caregiver...cuz I stayed at the hospital during her illness) wakes up enough to get their wits about them, let the fog clear from slumber before launching into whatever needs to be discussed in the 5 minutes you have with the patient.

Please (at least) familiarize yourself with alternative therapies and treatments. When patients suggest holistic or alternative therapy, have an idea about what they are talking about. If you don't know about it...please google it. Melody's oncologist said that she would totally support her in any decision that she made, be it holistic or traditional. We tried the traditional... got nowhere, so we went holistic. But when we needed her to do a few things (like return phone calls about concerns, run some test...etc), she was nowhere to be found. Say what you mean and mean what you say.

Lastly, Melody was a painter, writer, and a bunch of other things. The following was written by her after she was diagnosed. It's a little harsh but it was how she felt when she was told and her impressions of the doctor that told her.

"Dear Doctor,

I saw that! That look that just crossed your face! You f*#&ing bitch! You've already made up your mind that I'm dead. You've decided hook, line and sinker that this body has had it. Well let me tell you a thing or two.

First, as a doctor you need to cultivate a poker face. When your patients see your thoughts in your expressions they will, in many cases, subliminally accept them as truth and they will therefore become manifest whether they are right or wrong. Those strong enough to recognize and defend themselves against your negativity have enough to battle against already and adding your thoughts to their list of foes simply sucks up energy they need to fight the disease.

Second, you need to take your cues from your patient. If the patient is hopeful and positive, you need to support that and mirror that in your behavior. Of course we know the truth of our situations and are not walking around delusional. We got the damned diagnosis and we know that your drugs fail 99% of the time, but we trust you to do what you can and when you look at us with death and pity in your eyes you undermine everything we've fought against.

Third, you need to have a little faith. Faith that your patient knows how to best deal with illness. Faith that your patient knows their body better than you can ever hope to and is the best person to consult when you need to know what is going on. Faith that you don't know everything and that that is alright. We all walk uncharted territory each day when we awaken from slumber and we can learn something in each waking moment as long as we pay attention. Pay attention to your patient and serve them in the manner they require of you. Most of all, believe in them. They deserve at least that much from a profession that can offer them little else.

A Cancer Patient"

Again, thank you for your pursuit in being the best doctor you can be. Good Luck!

Sent by Michael | 1:27 PM ET | 03-09-2007

My doctors at Sloan-Kettering were great, but yes, limited on time. A good doctor should utilize his fellows and nurses appropriately to create an effective team of care and communication. The doctor might also want to review not only scans and tests before seeing his/her patient but also keep notes about a patients personality and specific needs. A patient likes to know that his/her doctor can pick up where they left off last time and remembers their concerns.

Now — a big issue is whether doctors should engage in email dialog with patients. Apparently, health providers have begun to cover emails as a billable service for doctors. In my case, I had one nurse who was email savvy and spearheaded a project to utilize it more effectively at Sloan-Kettering. Most others were reticent to use it, probably in part due to potential perceived liability issues. But I think many patients, would like this option, especially for non-urgent matters. Doctors need to find a suitable way to utilize it.

And lastly, why do radiation oncologists charge four times as much as a "regular" oncologist!?

Sent by Glen D. | 3:38 PM ET | 03-09-2007

I am a 30 year survivor of cancer... Yes my first cancer was 1977 and only with the help of the American Cancer Society - at that time - did I get all my questions answered.

And I agree, only someone who has been through cancer totally understands what it is like to go through this.

My most recent cancer was in 2005. And I'm very interested in the research that is going on about the mutation of cancer cells. Obviously I have some cells in my body that mutate and change over time and activate into new tumors in various parts of my body.

THANK GOD for early detection, quick surgeries and treatments — so Im still here to promote EARLY DETECTION, LEARN ALL YOU CAN, BE AN ADVOCATE for your own health care AND find doctors who are willing to advocate with and for you!

Being honest is at the top of my list of "Need from a Doctor."

The other big one is — Don't drop the diagnosis on the patient and then say, "Well, lets just see how it goes!"

NO, lets not just see... have some sort of plan, some options to suggest, some literature to share, SOMETHING!

Suggest the patient do research on the internet, contact ACS, etc, etc... GIVE THEM SOME HOPE whenever possible.

To the patient: KNOW YOUR BODY! YOU know when something isn't quite right and keep after the doctors until they find what it is! ESPECIALLY if you have had another type of cancer.

Thanks for letting me share!

A SURVIVOR!

Sent by Anna | 3:51 PM ET | 03-09-2007

I wish that I could say that my mother's doctor never said I have to go. The first time we saw both her specialist and the medical oncologist, it seemed that they were heading back towards the door right after delivering a news very unclearly and when asked questions being evasive and trying to "soften the blow" as you had mentioned. When I later asked my father why the doctor would not just answer my questions properly, he stated, they don't want to say anything dire in front of the patient. I thought, why not? Shouldn't every patient have the right to know the exact diagnosis and prognosis of their situation. I remember, it was hard to even get the specialist to explain how he reached the diagnosis that he did. As I said, only some are lucky enough to have doctors that will spend the time the patient and their family needs to answer all questions. Others, like people with Kaiser Permanente, end up with the short end of the stick. Rushing through our questions before the oncologist jumps out the door.

Sent by RK | 4:31 PM ET | 03-09-2007

I was treated for Testicular cancer this past fall. All went well for the few months of necessary surgery and treatment.

What I haven't noticed, (haven't read all comments), was the special care I received in Canada.

The Canadian medical system is maligned often, probably by the American HMOs, or that "group". Each Province runs their own autonomous plan, and Quebec gave me the finest and most organized, compassionate service I could ever expect. I only paid for off-site imaging, at less than the cost in the US.

As anyone that's been through the "system" knows, there are a lot of appointments to coordinate behind the scenes.

The Montreal General Hospital did it all very well. If I may make a "funny", I wouldn't mind getting sick there anytime!

Hats off to Socialized Medicine!

Sent by Andrew Golt | 6:14 PM ET | 03-12-2007

Others have written of the positives. As a wife of someone who survived 2 types of cancer but not the third, i have some other comments.

First, read the stephen jay gould article about his own view of cancer...about fighting to be in the 1%~! And the pointlessness of statistics to a medical patient. If you are the 1% who survives, that is all that matters to you. So the issue for any doctor & patient is to work as a team to get the patient to be in the tail of the bell curve that survives~! What not to do....don't distance yourself from your patients and their support system because they will want you to be part of their team. Don't avoid tough questions. Don't assume your words make sense. When my husband was told he had a yeast infection after chemo, we had no clue this was life threatening because we had only known about women getting vaginal yeast infections. No one mentioned it was in the bloodstream and could kill him~! Dont forget to offer choices, even if that choice is do nothing, begin hospice services, etc. The oncologist was so gung-ho and aggressvie w/ treatment plans he never mentioned the option to stop treatments that were going to create more side effects than positive outcomes. Be brave enuf to say the truth...yes one outcome is x, but another outcome is y....some of what we heard was like listening to a sales pitch. It was too much high hopes that kept being dashed without warning. Work with a whole treatment team. In our san francisco hospital with all its complementary medicine stuff going on, the non-traditional folks never spoke to the traditional medicine folks. The oncologist managing the medical case had no contact w/ the massage therapist, the guided imagery meditation specialist, the chaplin who my husband adored...had they worked together in unity with him..and me..and our daughter....we might have all been on the same page rather than disconnected and often at odds with each other.

Recognize that weekends in a hospital are scary because none of the regular staff who know the whole picture seem to be around. We only saw on-call folks, residents with no clue of the whole case and it terrified me no end~! I know that doctors need time off, but maybe some plan for critically ill patients and their families would allow for continuity with weekend coverage, at least by phone w/ the primary treating doctors.... And all that popping in and out w/o warning means that the key family/support people may not be present when the doctor stops by...if it is possible to plan the timing on those quickie in hospital visits, it would reduce anxiety. My husband always wanted me there when the doctors talked to him because he was cognitively impacted by the chemo and other treatments as well as the cancer. But if i ducked out to make a phone call, use the bathroom, get food, i might come back and find id missed the doctors yet again..so id have to page them and that created more chaos for them. There must be a way to make communication better. Ok. Enuf complaints.

Sent by Cg | 6:16 PM ET | 03-12-2007

Dr.Tejura,

Thank you for asking, first of all. I believe you are choosing a very difficult field for a human being to be in. It is probably as difficult to be a cancer patient. I am a cancer patient but I am not a doctor, so I'm going out on a limb here.

As a patient I could repeat almost all the suggestions so for submitted. They are all thoughtful and good ones. I only ask, emphasize and repeat yes we need straight answers but we need compassion and a little piece of hope more than anything. With hope we can do amazing things — this blog is filled with our triumphs. Not one of which is small.

Blessings to you on your journey, take good care of yourself.

Sent by Penny | 6:18 PM ET | 03-12-2007

LISTEN to your patients. Listen to what they say, what they DON'T say. READ THAT PART AGAIN. Little ticks me off more about doctors is their lack of listening skills. I refuse to go back to doctors who don't listen and/or who ignore my input. This is MY BODY!

Be compassionate and be truthful. Understand that you have training in your specialty, but not every body responds in the same way. If someone says it is too much, find out why, maybe back off and try something else. Understand that patients, no matter what they say, are probably scared underneath it all.

Sometimes, people just need a hug.

Sent by Kaleb | 6:19 PM ET | 03-12-2007

By asking this question, it is obvious that you will be a good doctor. As a cancer patient, my first suggestion is to never stop asking yourself this question. Most of my doctors have been good to great, but not all of them. I was diagnosed with cancer at 32, shortly after my first child turned one year of age. I have a rare, incurable, slow growing cancer in my abdomen. The experts estimate that the tumors began growing 6 to 7 yrs. ago. I had been going to different doctors for 6 to 7 years complaining of abdominal pain. Once I was FINALLY able to see a GI specialist, the FIRST words out of his mouth were, "you are too young to have cancer and I am sure that there is nothing seriously wrong with you." I felt like an idiot and a hypochondriac. Two years later, I saw a new physician who finally scanned me and told me that I had stage 4 cancer.

As a new physician, please remember that young people do indeed get cancer. Also, please know that many people are embarrassed or shy to complain about their ailments and that comments such as I heard can keep one from seeking care. I blame myself for not pushing the issue further, but after seeing a clinic 7 times and being told that I was "paying too much attention to my body" (they never did a single diagnostic test), you stop listening to what your body is telling you.

Sent by Kate HM | 6:32 PM ET | 03-12-2007

I am overwhelmed with the responses that you all have shared. I came across this entry this morning while I was showing a patient this blog for him to read to inspire him. As I pulled it up, and started reading, we saw MY NAME and MY question, and were shocked...

It is fantastic to read your responses. Your words have more meaning than you will know. I learn from you and all the people I've met every single day.

You have all made this journey and training more memorable for me.

Thank you for your advice.

p.s. As a sidenote: I am female. :)

Sent by Krupali Tejura MD | 6:33 PM ET | 03-12-2007

Dr. Tejura, Continue to be the type person that would even ask "what can I do better" or "how can I better serve" — I think that speaks volumes and with your formal training, you will be 2nd to none.

Sent by Connie Perry | 6:34 PM ET | 03-12-2007

As a physician I realize that we can seem cold and insensitive at time, but most of us are trying. Thank you for your words of advice and sharing your experiences. Please know that there is a lot of stuff that is beyond our control and that when we are late for an appointment its often because we are spending more than the allotted 15-30 minutes per patient. As one person commented, doctors are human with all the frailties and faults that go along with that. Thank you for reminding me about the power of ones words both to harm as well as to comfort.

In the words of Sir William Osler, "To cure sometimes, to comfort always."

Sent by Christopher Blewett | 11:57 AM ET | 03-13-2007

What I have appreciated about my doctors is that they know ME. They remember my name, my occupation, other things happening in my family (just today I saw my surgeon for a follow up- his nurse was asking me how my father is because she remembered that I had told her he has lung cancer), they celebrate with me (when I saw my oncologist yesterday and got great news, I ran back to see my oncology nurses and they hugged me and laughed with me). When I see my oncologist around town (I live in a small town), he says hi and we talk about things other than cancer. He likes to walk back to the treatment room between patients (sometimes just looking for some candy for his sweet tooth), and he will talk to us about non-cancer things - like India, Gandhi, civil rights, religion, or whatever is on his or our mind that day. It makes me feel like both he and I are real people that exist outside of cancer cells, and that the world is going on beyond the drip drip of my IV.

Sent by Kelley | 12:00 PM ET | 03-13-2007

My late wife's cancer doctor gave my wife, her mother and me, her husband the news about her Lung Cancer and said that we would start Chemo and her hair would not fall out and the cancer would probably go into remission and eventually come back. I took the doctor aside and asked him why he did not tell my wife that she would not beat this and he responded to me that she could not handle that news. One year to that day my wife passed away due to an infection in one of her lungs that caused Respiratory Failure. When she passed away, her cancer doctor was out of country and his departing words were that as soon as he got back, he would perscribe more chemo. This was said as she is in the emergency room after being released for about 36 hours and having to return to ICU because she could not properly breath. Four days later she was gone and never had the courtesy of the doctor informing her that she would not beat this battle. During my wife's one year battle she put her trust in the doctor and he sugar-coated every scan result and she would leave the doctors office feeling better about her chances. She never had a say in her treatment because she trusted her cancer doctor and he never told her that this cancer would not be beaten. I later researched and found the cancer doctor to have gotten his cancer doctor license only 5 months prior to treating my wife for the first time.

Sent by Steve Higbee | 11:10 AM ET | 03-16-2007

I am very grateful to the radiologist who said not to trust my biopsy results if they came back negative. She had a bad feeling about what she was seeing, and she was correct. I appreciate her candor with me. To my two male doctors who rather flippantly said they could put me into menopause with a shot to facilitate further treatment, please understand that menopause is a big deal to some women. I, too, appreciate the doctors who took the time to answer questions and address fears.

Sent by Caroline Thompson | 5:35 PM ET | 03-19-2007

Dear Dr. Tejura, I offer my responses to your inquiry in no particular order—assign them heirarchical value as you see fit. The order may change from one day to the next, in fact. And I thank you from the bottom of my scabby little heart for asking.

First: determine whether you're in the field of medicine to treat patients or to treat disease entities. One is very different from the other. I am more than simply a package for a particular disease entity, and I will remain even as the disease entity is dealt with—I am a whole patient, to be dealt with wholly.

Second: try always to bear in mind that your particular field may not offer the best solution. A proverb comes to mind that if the only tool you have is a hammer, then every problem starts to look like a nail. I'd hope that you never try to fit the problem to a given solution. Be open to and informed about other possible options. We patients are going to be clutching at as many options as we can reach, and well have lots of questions. And in Cancer World, all questions are good questions, worthy of respectful answers.

Third: Be aware that a patient's most recent experience with any other doctor will color their anticipation of your behavior. Be as well prepared as you can to speak to the individual who has come to you, so that no matter how bad the last doctor was, you will restore their faith in the treatment system and process. And if their last experience was wonderful, then hold your own with that wonderful doctor. People dealing with a catastrophic diagnosis are by that very fact going to be needy, grieving, suspicious, terrified, angry and grateful, relieved, humorous, and trusting by turns, sometimes within the span of a 15-minute visit. Be ready for a roller-coaster ride, and try to remember that the patient isn't controlling it. (You may not be, either, but you're a lot less impaired than the patient, or even the person who may accompany them to see you, and thus in a better position to try to control it.)

Fourth: I was happy to see others saying this, but be sure to have your own pressure-release mechanisms, your own sense of solid ground on which you can stand. The pressure on you will always be tremendous, in part because each patient who comes to see you will be different from all previous patients, but the fear and anger and desperation will differ only in orders of magnitude. Whether you choose to work out, or paint, or meditate, be sure that you carefully manage your schedule so that it includes time for you to recharge. Don't try to save the whole world at once—well be lined up and waiting no matter what. Just do what you can and do it as well as you can each time you see a patient.

Fifth: Listen to all that the patient is trying to tell you I know some of us are more garrulous than others, and some are maybe less articulate than you (or even they) might wish. But it's better actively to rule out a concern than to dismiss it without a proper hearing.

Sixth: I would suggest that any doctor ask him or herself each day "What can I do better today, and how?" Don't stop asking just because you're now in practice. Every day and every patient has the potential to teach. The more we all know, the better we can work together and maybe someday vanquish cancer completely.

Thank you for being curious enough about us patients to ask us for our thoughts.

Sent by Ginny | 5:36 PM ET | 03-19-2007