Example of a patient–physician discussion about social burden
cancer, my illness, Psychiatric, tumour
CANCER, DISEASE, SAID, TUMOUR
Patient: I planned to move in with my partner after my hospital stay. She’s a former nurse, but now a relative of hers has died.Chief physician: Oh dear.Patient (tearful): When she heard what could happen to me, she said no. I mean, over the last years I’ve burdened her with my illness. But now I am really down.Chief physician: Yes, that is… I can understand that.Patient: Now I had to agree with her and promised to look for assisted accommodation.Chief physician: Yes, we can discuss this with our case management team. Or have you already found something?Patient: No, because I expected to move in with her. But now her relative has passed away and it is all so complicated…Chief physician: Yeah, I understand! But unfortunately, we don’t have much time during the ward round so we’ll have to discuss your further care on another occasion.Patient: Okay, yes, thank you.Another frequently encountered sensitive topic concerned tumour diagnosis. Previous literature has shown an association between physicians’ communicative competence and its effect on quality of life in patients with cancer.Psychiatric comorbidities and psychological issues are also perceived as sensitive topics and may be directly linked to physical disease. Physicians often hesitate to address mental health issues during the ward round because of a lack of privacy.Recent studies highlight that medical uncertainty remains a significant factor in medicine despite the advances in diagnostic possibilities particularly in patients reporting various unspecific symptoms.Importantly, our study found lower satisfaction in patients with sensitive topics compared with patients without sensitive topics. This may be due to confounding because patients with sensitive topics are often more complex and have different medical needs. Interestingly, previous literature in outpatient settings suggests that adequately addressing sensitive topics is associated with higher satisfaction.Over the last decades, medicine has shifted from a paternalistic to a participatory, patient-involving model, with shared decision-making as a key element. Schifferli hypothesises that disagreements between patients and physicians may be a consequence of increasing patient involvement and highlights the importance of patients’ wish for participation in clinical decision-making.