A neuro-oncologist by training, Andrew Norden joined healthcare data and analytics company Cota Inc. as chief medical officer in September 2017. Norden was previously the deputy chief health officer for IBM Watson Health and has worked as a practicing physician and attending neuro-oncologist at the Dana-Farber Cancer Institute in Boston for a number of years.
I learned a lot about communication as a practicing physician There are few scenarios when communication is as sensitive as when you are a doctor taking care of a patient with a potentially life-threatening illness.
When I first graduated from medical school and did my training, I saw examples of patients being given false hope. I vowed early in my career that I would not be one of those doctors. I would be one who was honest with his patients. I sort of had the philosophical approach that honesty is always the right answer.
Early in my career—almost 10 years ago—I saw a patient who had metastatic breast cancer, and the cancer had spread to her brain.
She was a scientist by training and worked as a biologist, so very quickly I assumed that because she was a scientist she would want to understand her situation in great detail.
As an oncologist, you often feel reluctant to share published research about prognoses because every patient is somewhat unique. It’s hard to know sometimes how published numbers relate to a specific individual who’s sitting in front of you.
When I met this woman she was feeling and looking very well at the time of our visit, and I had recently read some of the latest research that had come out about predicting prognoses in patients with metastatic cancer to the brain.
When she asked about her prognosis, I pulled out the paper and showed her, using the published numbers, that the average survival for a patient in her predicament was about six months.
She was completely shocked and emotionally broke down. Very quickly that shock and sadness turned into anger and she stormed out. I never saw her again.
I called her and she wouldn't take my call.
Ask people what kind of information they want to hear how much, and how detailed the information should be.
I learned from that experience that it’s really critical to ask people what kind of information they want to hear how much, and how detailed the information should be.
I don’t think in the business world the stakes are often quite that high. You’re not often talking about life and death, but certainly, there are times when we’re giving bad news that may affect people’s livelihoods. That was a really important lesson.
I never had an experience like that subsequently, because I always gave people the opportunity to tell me how much or how little they wanted to know.
I’ve learned that to my surprise, a lot of patients with really serious, incurable cancers simply don’t want to know the population data. They want to be left with some hope that they’re going to do better than average. They want their doctor to be there listening and managing their symptoms. A lot fewer people than I would have thought actually want to know what the published literature and data says.
I take that as a lesson that I have since carried forward to all of my communication. It’s really important to be sensitive, particularly when delivering any kind of bad news, and to understand what kind of information and how detailed your audience wants you to be and what that person is able to process.
Photo courtesy of Cota