The vertical hour (June 2007)

Your editorial The vertical hour raises important points about doctor/patient communication, the topic of breaking bad news, and how cancer care has become at times wonderfully multidisciplinary and at times woefully fragmented. As a medical oncologist for over 25 years, I can say that one of the most satisfying parts of the job has been close collaboration with surgeons and radiation oncologists. I remember a lesson I was taught in medical school about breaking bad news. The message was to have the person relaying the extent of the bad news be the same one to tell the patient what could be done about it. I understand your desire to be forthright with the facts, but I suggest that at your side be the medical or radiation oncologist. The medical oncologist can provide insight about systemic therapy options, and the radiation oncologist can inform the patient and family about local treatment options and symptom prevention. Such team delivery of bad news can be powerful, with full information, a preliminary plan, and hope all provided in a way that demonstrates communication within the multidisciplinary group. It takes some time to coordinate this, but patients and families are grateful.

James A. Stewart, MD
Madison, WI