Bob Arnold, a palliative care physician I’d met from the University of Pittsburgh, had explained to me that the mistake clinicians make in these situations is that they see their task as just supplying cognitive information—hard, cold facts and descriptions. They want to be Dr. Informative. But it’s the meaning behind the information that people are looking for more than the facts. The best way to convey meaning is to tell people what the information means to you yourself, he said. And he gave me three words to use to do that. “I am worried,” I told Douglass. The tumor was still there, I explained, and I was worried the blockage was likely to come back. (Location 2658)
Last week, I completed my note about Cerebellopontine Angle (CPA) Tumor where I read a fascinating treatment option: observation. Since 85% of CPA tumors are benign, observation became an option. Doing nothing but watch it slowly grows. From a palliative perspective, this makes sense. In fact, it relates to what Atul Gawande observed about what does it mean to be either Dr. Informative or Dr. Knows-Best (Paternalistic model).