When this physician was diagnosed with cancer, she confronted her assumptions about patients, communication, and education.
Board-certified family physician Dr. Beverly Zavaleta tells us what happened, and how it changed her practice.
Listen below, or read the transcript.
At Health Communication Partners, we work quite a lot with communication between patients and clinicians. But what happens when a clinician becomes the patient?
Today you’ll hear about how one physician came face to face with her assumptions about patients, communication, and education–when she herself was diagnosed with cancer.
This is 10 Minutes to Better Patient Communication. I’m Dr. Anne Marie Liebel and I’m talking via Skype with Dr Beverly Zavaletta.
Good morning, Anne Marie. Thank you for having me.
Thank you for being here. Can you tell our audience a little bit about yourself and what you do?
Sure! I am a board-certified family physician which is primary care of course and I also worked for many years as an adult hospitalist, doing hospital medicine which is basically General Internal Medicine, Adult Medicine in hospital.
Thanks for that. You had a set of events in your life that changed how you think about patient communication and patient education. Can you tell us some of what happened?
Sure. So back in 2015 I was diagnosed with triple negative breast cancer, which is a very aggressive form of breast cancer. and for 11 months I was out on complete disability, having aggressive chemotherapy followed by surgery and then recovery period after that. so I got a very close up look at living with a serious illness and recovering. and during that time I was doing my research, trying to take care of myself. and I also got a chance to help other people who are going through similar serious illness with chemotherapy, because friends and neighbors came to me with their questions about cancer, cancer treatment, chemotherapy as well.
Well that makes sense that they would come to you. so where have you been in your thinking about patient communication and education up to this point?
Yes so early in my practice, maybe 10 to 15 years ago, I looking back at it, I realize that I was a little bit naive about my role. I think I, without realizing it, I was a little bit more maybe evangelistic in how I went about teaching. I, I was very enthusiastic. Had just come out of residency and I was armed with this knowledge. And I was making a bunch of handouts at my clinic and I would pass them out. And I, I was maybe just spewing information. And I had this idea that if I could just arm the patients with facts, than they would be able to just carry them out like–like as if it were a recipe or something. And that was naive because it just it doesn’t really work that way. But I didn’t I didn’t realize that. And the crucible of getting cancer and having chemotherapy taught me a lot. Being a being a patient and needing a lot of guidance and teaching myself.
How would you how would you describe your your approach to patient communication and education now?
I would identify two main changes, and that would be more compassionate and more reciprocal.
What do you mean by that? You’ve become, you’re, your approach as more compassionate and more reciprocal.
So I believe that every clinician, everybody in healthcare–doctors nurses Nurse Practitioners mid-levels everybody–really wants a patient to succeed. That’s why we do it. But when started my practice I just didn’t appreciate what it really meant to live with a serious illness. I thought I did, but I didn’t. And I think people who are living with serious illnesses are just literally trying to get through the day. And people can be good fakers. I can be a good faker. You get up, you get dressed you try to look normal. You comb your hair, you smile. And if the doctor or the clinician, the nurse is not looking carefully you don’t realize that people are faking, and people can be hiding their suffering. And I was not aware of that. So going through this experience made me honestly more compassionate. And the compassion I think leads to reciprocity in that communication.
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Wait, well tell me about that. what does that mean to you ?
So communication and patient education is not a one-way street. So unlike what I used to do, it’s not like I open my mouth and a flood of brilliance comes out, showers the patients, and they have an epiphany and they walk on their way. It has to be a feedback loop. So I can’t teach somebody if I don’t know where they are.
I can’t tell you how much this is making me smile! I wish that the audience could see me smiling at what you’re saying: it’s not just a one-way street. This compassion leading to reciprocity. So how do you do this more compassionate more reciprocal communication and education?
So I would say that I have my sensors tuned up. It’s, my experience has amplified my listening. I’m more appreciative of detail. More focused on the patient. I start with the patient instead of the material–instead of being an evangelist for the material that I want to transmit. That’s out the window. I engage with the patient first. Figure out where they are, instead of focusing on trying to give a lecture.
You just wrote a book about this that’s just come out, called Braving Chemo. Can you tell us about your book?
Sure, of course! I wrote Braving Chemo: What to expect, how to prepare, and how to get through it and it was released in 2019. It’s a practical guide to assist patients to get through chemotherapy, manage side effects, and recover.
I’ve gotta to ask though: why this book? Because there are so many other resources out there.
Yes that is true. Doctors do a lot of education. nurses to education. There are chemotherapy classes. but every patient is different; people learn in different ways. And they need, many people need more information and they need it over time. So the book Braving Chemo is concise. It’s all in one place. It’s written in plain language, easy to read, easy to use. And I found that many websites are very dense and use complex language. So the book doesn’t require searching on the internet, scrolling through different pages. So it just offered another resource that was a little bit different from what’s out there.
Right, you’re not trying to replace the chemo classes.
Oh for sure not absolutely not. It’s just, I add an additional resource.
And it’s interesting to me that you’re talking about concise, in one place, easy to use–because for me this goes back to what you had said about what it means to live with a serious illness, and when it comes to looking for your own resources and trying to make sense of them as a patient. That’s–I’m thinking about that right now from a health literacy standpoint.
Yes. When you’re on chemotherapy, you’re exhausted. You have about a 90-second attention span. You’re tired, you hurt your feeling sick to your stomach. Ao you really need something that is quickly accessible and broken down into tiny bites. So each section of this book can be read as a stand-alone section so you don’t have to read it end to end in order to get the value. It’s just in little tiny information bites.
I love that. I think that’s an aspect of health literacy that just does not get enough attention, and that’s the energy it takes to make sense of what you are reading or hearing or viewing. Because sense-making a complex process. It’s person specific, it’s context specific.
I appreciate your drawing our attention to that. So what could you tell the clinicians in our audience about patient communication and education that might be helpful to them?
I think that my most important points that I would recommend would be to remember that patients probably need more information than you think that they do. I also recommend asking them what information they need, and offering a variety of resources.
It’s also important to repeat this process frequently over the course of treatment because patients’ needs change over time. And remember that when patients are overwhelmed they’re going to have difficulty remembering information and carrying out whatever the recommendations are. So sometimes clinicians can get frustrated if a patient can’t do something. but that is probably because they’re suffering or feeling ill.
Right, right. Dr. Beverly Zavaleta author of Braving Chemo, thank you for this, thank you for being on the show.
Thank you so much, it was a pleasure to be here.
This has been 10 Minutes to Better Communication from Health Communication Partners. I’m Dr. Anne Marie Liebel.
Reach Dr. Zavaletta on her website and on Twitter and Instagram at @BZavaletaMD
N.B. Health Communication Partners does not receive any compensation from sales of Braving Chemo