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It takes two

Author: Laurie Wertich

relationshipCancer treatment can present a long and winding road, marked by emotional and physical challenges along the way. Though the prospect may seem daunting, building good rapport with your doctor can help make that journey a smooth one. In fact, many patients report that building a healthy patient/physician relationship had a positive impact on their treatment. But how can you cultivate a solid relationship with a busy doctor who has an endless list of patients to see? Actually, it’s not all that different from any relationship; a little respect and communication go a long way.

The patient/physician relationship

Once upon a time, the medical system operated on the premise that “doctors know best.” Patients visited doctors, doctors gave orders, and patients generally followed those orders without question. The doctor was an authority figure, and the patient/physician relationship most often resembled a child/parent relationship.

But a new era has dawned: a look at patient/physician relationships today shows us that we are shifting from a model wherein the doctor is the authority to one in which he or she occupies the role of expert consultant and, ideally, partner, alongside an empowered and educated patient. This evolution places the patient firmly in the driver’s seat, an active participant on the treatment journey.

People relating to people

Shayma Kazmi, MD, a hematologist-oncologist and medical oncologist at Cancer Treatment Centers of America® (CTCA) in Philadelphia, Pennsylvania, strives to encourage this new model of partnership in her work with patients.

Key to this effort, Dr. Kazmi says, is building relationships with her patients. “It’s important to try to get to know the patient,” she explains. “They’re not just about the cancer. There is so much more going on that may not have anything to do with cancer. The more you learn, the better you can treat them.” When she meets new patients, Dr. Kazmi tries to learn how they do things at home, what is important to them, what kind of family obligations they have, and more. “If you don’t know all of that, you miss a big opportunity to treat them fully,” she insists.

Dr. Kazmi believes it is critical for both patients and doctors to be as frank and open as possible. Sometimes patients are afraid to tell their doctors certain things, but Dr. Kazmi says that the more she knows, the better she can help. “This is about the disease and your treatment, and I’m here to help you,” she tells patients. “You can do whatever you choose. You’re empowered, and I respect that.”

As a patient of Dr. Kazmi’s, Pam Cromwell, a business analyst from New Jersey, can attest to the positive impact of her doctor’s efforts to connect on a personal level. Though Pam is currently living with stage IV breast cancer, she jokes that her “Jedi mind trick” allows her to fake it much of the time and forget that she has cancer—except when she sees Dr. Kazmi. “Dr. Kazmi sees me at my most flawed,” Pam says. “Other people see me as Pam the businesswoman or Pam the church girl, but she sees me as Pam the cancer patient, and that’s where I’m most vulnerable.”

For Pam this vulnerability is the key to her relationship with Dr. Kazmi. She feels a certain sense of safety and comfort with Dr. Kazmi that she hasn’t experienced with other doctors. “Anyone can go through the proper education to become a doctor, but not everyone has the true compassion to be a doctor,” explains Pam. Right away Pam knew that Dr. Kazmi was different. “She won me over with her honesty,” Pam recalls. “It was sincere honesty. She was real about what I was going through, what her knowledge was, and every option she gave me. She never gave me that 100 percent guarantee.”

From there the relationship unfolded. Pam found a place where she could be real. She let her guard down, she cried, she asked questions, and she shared her fears. She also found the strength to keep enjoying her life. Both Pam and Dr. Kazmi recount the story of Pam’s new kickboxing habit. “I will never forget the look on Dr. Kazmi’s face when I told her that I had started kickboxing,” Pam laughs. “People with cancer in their bones probably shouldn’t be kickboxing.”

Dr. Kazmi took it in stride. “Pam told me that she really enjoyed it and that it made her feel like a real person,” Dr. Kazmi recalls. “I just sat back and laughed and told her that as long as she was very careful, it was okay. She knows I’d rather she didn’t do it, but I’d rather know about it. If it’s important to her, it’s okay with me.”

This kind of openness between doctors and patients is critical, Dr. Kazmi says: “The more open they can be, the more you can learn and the more you can enhance treatment.” Dr. Kazmi makes this sense of openness a priority. She wants her patients to be able to live as normal a life as possible. Pam sensed this—she felt like she really mattered and that Dr. Kazmi wanted the best for her. “I need the warm and fuzzy,” Pam says, “and I need to know that I’m not just a number. I know she has a full life. She has many, many patients. But she’ll take 45 minutes to an hour with me and never makes me feel like I need to rush or like I’m messing up someone else’s appointment.”

Perhaps the bottom line is that Pam simply felt comfortable with Dr. Kazmi, and Dr. Kazmi says this might be the most important part of the patient/physician relationship. “If you’re not comfortable with a physician, don’t feel like it’s rude or insulting to switch,” she urges. “It’s your life. They’re not going to get offended and, frankly, if they do, who cares?”

Communication is key

As is clear in the case of Pam and Dr. Kazmi, a healthy patient/physician relationship requires a desire on the part of both parties to listen and to be heard. Dennis Citrin, MD, PhD, a medical oncologist at CTCA in Zion, Illinois, believes that this type of communication is the key to fostering healthy relationships with patients. “A patient/physician relationship is like any relationship: there has to be good and honest communication between the people involved,” Dr. Citrin says.

This communication forms the cornerstone of Dr. Citrin’s relationships with patients. “I always encourage patients to ask questions and really understand the answers they get,” he explains. “The more they understand about their situation, the easier my job becomes.”

He sees the patient/physician relationship as one based in mutual respect. Although he may be the cancer expert, his patients are experts regarding their own lives and needs—and the patient is the focus. “The patient’s welfare is paramount. That is the most important element,” Dr. Citrin insists. “I listen, answer questions, and offer support—and the relationship evolves from that.”

Terrece Crawford, a busy single mom and an art teacher from Kenosha, Wisconsin, is a patient of Dr. Citrin’s, and she has seen firsthand the positive experience of solid communication built on a foundation of respect.

When she was diagnosed with stage II invasive ductal carcinoma, Terrece says she initially felt as though her life came to an abrupt halt. All she could think about was her children. “I didn’t even care about myself at that moment,” she recalls. “I just thought, I have to be here for my children.” The sense of fear she felt was overwhelming— until she met Dr. Citrin.

“Dr. Citrin was so kind and compassionate. He told me I had hope, but I didn’t believe him,” Terrece recounts. “But he is a wise doctor. He understands people. He leaned in closer, looked me in the eye, and said, ‘You do have hope, and you are going to be okay.’ That was a turning point for me.”

“Terrece had early-stage breast cancer, so her prognosis was excellent, but her treatment and follow-up is a long journey,” Dr. Citrin explains. This long journey provided the opportunity for the two to develop a solid patient/physician relationship. “Some patients are more guarded, but Terrece came to look on the team here as being a very important resource for her in terms of support,” Dr. Citrin says. “The environment we provide here is pretty unique. We encourage patients to express themselves, ask questions, and understand the answers they get.”

By empowering Terrece as a patient, Dr. Citrin opened the door to building a solid working relationship. “Dr. Citrin took time with me, and I did not feel rushed,” Terrece says. “I opened up to him because it would help him understand me. He wanted to know that I was okay as a person, and that helped me feel like I mattered. It was not just about cancer: as his patient, it was about being a person.”

At the beginning of her cancer journey, Terrece painted a self-portrait and showed it to Dr. Citrin. “He told me, ‘That’s what I like to see: patients doing something positive about their journey,’” Terrece recalls. She had been feeling shy and insecure about her talent, but the positive feedback from Dr. Citrin encouraged her. By the end of her treatment, Terrece had created 25 works of art, including self-portraits to document her journey.

“My relationship with my doctor completely affected my outcome,” Terrece insists. “I really believe that. Dr. Citrin always encouraged me. He is an amazing person, and I trust and respect him. He saved my life.”

In it together

Your doctor knows cancer, but you are more than your cancer. When you reveal the real you and ask questions and share your hopes and fears, you give your doctor an opportunity to know you—and this can help guide treatment. Remember that you’re both on the same team, and you both have the same goal: to beat cancer. Keep it real, communicate clearly, and establish a level of mutual respect. Together you and your doctor can navigate cancer.

No case is typical. You should not expect to experience these results.

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