Explaining Disease: An Important Part of the Doctor-Patient Relationship

My medical school, The University of Chicago, implemented a novel approach to teaching students about the doctor-patient relationship during my tenure there in the 1990s. In an effort to nurture a stronger sense of empathy and compassion among the doctors-to-be, the Clinical Skills faculty decided that all students should spend a long weekend as a hospitalized patient. We were admitted in the standard bureaucratic fashion, wheeled down long hallways on noisy gurneys watching fluorescent lights nauseatingly flash by overhead, and treated like just another disease. IVs were inserted in our veins, we ate institutional, disease-specific diets, had our vitals checked all day and night, and were poked and prodded endlessly like hospitalized patients typically are. The experience was very unsettling, to say the least.

It worked. I remember these particular days as vividly as first year gross anatomy. Being on the receiving end of medical “care” can be unnerving and scary. This ingrained in me that the only way to treat people is the way I would want to be treated as a patient, with compassion and empathy.

Every day at work, I tell people they have cancer. In dermatology, though, we are most often diagnosing non-melanoma skin cancers. While these are malignant lesions, one could easily become perfunctory in discussing these conditions because they are so common and often straightforward to treat. However, I always remember that the “C” word can spark a feeling of terror when verbalized to a patient, so I keep that in mind when explaining the diagnosis. Again, I think, how would I feel if I were this person? When my patients return for Mohs Micrographic Surgery to remove a biopsy-proven facial skin cancer, I spend a generous amount of time at the outset conversing with them at the bedside. My goal is not only to explain the procedure, but to evoke a feeling of calm, trust and reassurance which is essential to a productive doctor-patient relationship.

What is Mohs Micrographic Surgery? A Mohs surgeon removes a level of cancerous tissue, draws a corresponding map to ensure proper orientation on the patient, and a Mohs technician sections and stains the tissue, which is mounted on a microscope slide. The Mohs surgeon then reads the slide to determine which margins still contain cancer cells. This process is repeated until the lesion and any cancerous “roots” have been completely removed. At this time, the surgeon closes the surgical wound using one of a variety of reconstruction techniques. Mohs micrographic surgery remains the most advanced and effective procedure for treating many skin cancers, especially those on the head and neck, and boasts the highest cure rate of all treatments for indicated skin cancers.

The dermatologists in our group are qualified to practice Mohs micrographic surgery by having met high standards in surgery, patholog, and reconstruction as established for fellow membership in the American Society for Mohs Surgery (www.mohssurgery.org). Northern Arizona Dermatology Center is the only Mohs surgery center in the region.

All of our board-certified dermatologists are committed to delivering exceptional service and high quality medical care in a professional, yet friendly, atmosphere. Our practice has proudly served Northern Arizona for 45 years, and we deliver caring expertise at Flagstaff, Sedona, and Cottonwood locations. Please visit our website for more information, and to make an appointment for your skin examination www.nazderm.com. FBN

By Scott Dale, M.D.