We all fail sometimes. Maybe we did not get the job we wanted. Maybe an important personal relationship did not work out. Perhaps the bonus we expected did not come through. Life is full of disappointments.
But when we fail at something we are supposed to be good at, it is very painful. This week, I disappointed a patient. I disappointed him enough that he wanted to change providers. Naturally, I ruminated about this and relived every minute of the visit with this patient. This patient’s cancer had blown through our standard therapies, but the patient attributed his pain to a prior procedure and he delayed additional workup to attend an event out of the country. When he returned, his condition had deteriorated. I was worried about him. But my attempt to help him understand the gravity of his situation was interpreted as harsh and uncaring. It was not meant to be.
In thinking about this patient, I realized that our team had been besieged by a lot of demanding and challenging patients lately. Additionally, many of our staff had been out with COVID, and I recognized that, with cross coverage, some things really did fall through the cracks. So maybe, in some subtle way, the stress had interfered with my ability to manage a difficult conversation.
A restaurant I visit in my neighborhood has a sign on the door, “Please be patient. We are understaffed.” This sign manages my expectations. When I get my food in the customary timely way, I am pleased. If it is delayed, I understand.
We are all human, but I think that in clinical practice, we have tried to be superheroes. We carry on no matter the long hours and the stressful conditions. Our patients are scared, and when there are delays or shortages, their fear escalates. That fear often turns into anger—at us or at our system. Perhaps we, too, need a sign on the door asking for patience. It couldn’t hurt.
I am not making excuses for my failure with this patient. In reliving the visit, I realized I should have listened more and talked less. And I will send a note of apology. That’s a simple thing to do that I hope will mean something.
What did I learn from this? Well, for one thing, I am not perfect and I can’t please everyone. But then, I already knew that. I do think this encounter reinforced the importance of taking time with every patient, especially those who challenge us. It helps us understand the patient’s point of view and, in so doing, it helps us be better communicators.
So here I sit, pouring my heart out and eating humble pie. Thanks for listening!
MARGARET TEMPERO, MD
Margaret Tempero, MD, is a Professor of Medicine and Director of the UCSF Pancreas Center and editor-in-chief of JNCCN. Her research career has focused on pancreatic ductal adenocarcinoma, especially in the area of investigational therapeutics. Dr. Tempero has served on the ASCO Board of Directors and as ASCO President. She currently serves on the ASCO Conquer Cancer Foundation Board. She codirected the AACR/ASCO Methods in Clinical Cancer Research and taught this course and similar courses in Europe and Australia. She was founding Chair of the NCI Clinical Oncology Study Section and served as a member and Chair of the NCI Board of Scientific Counselors Subcommittee A. She is a member of the Scientific Steering Committee and Chair of the Clinical and Translational Study Section for the Cancer Prevention & Research Institute of Texas. She is or has been on the Scientific Advisory Boards of the Lustgarten Foundation, the Pancreatic Cancer Action Network, the V Foundation, The Alberta Canada Cancer Board, and the EORTC. She served as a member of the Oncology Drug Advisory Committee for the FDA. She has served as Deputy Director and Interim Director for the UNMC Eppley Cancer Center. She is Chief Emeritus of the Division of Medical Oncology at UCSF. She served as the founding Deputy Director and was later Director of Research Programs at the UCSF Helen Diller Family Comprehensive Cancer Center.
