Archives of The Cheerful Oncologist, Volume 2

tergiversate: to use evasions or ambiguities; equivocate.

Anyone who thinks doctors do not work under pressure obviously has never been sick. How soon we forget the last time we sat in an exam room or in the Emergency Ward and, just like on a soap opera, nervously waited for the physician to come in and tell us that “everything was going to be all right.” What rippling confidence he had as he put his arms around our shoulders! How relieved we felt with the first glimpse of his immaculate smile and his crisply ironed lab coat as he pronounced the phrase we so desperately needed to hear! How calm and collected he was all throughout this crisis! What a sweet surprise it was to be invited to his flat that night for an elegant dinner prepared by his lovable housekeeper!

Yes, what a wonderful conclusion it was - unfortunately it had nothing to do with us because this blissful scene was from an old T.V. show we watched last night. In reality doctors don’t have scripts to follow, or directors to prod them to a better performance, not to mention a pre-written happy ending followed by a word from our sponsor. On the other hand, in real life physicians are continuously doing an improvisational act in front of a very attentive if not critical audience, and with no intermission. Seriously, when was the last time you interrupted your doctor in order to get a snack? See what I mean? Patients, especially the very ill, tend to hang on every word emerging from the doctor’s mouth.

Not that there’s a problem with that. It’s just that when communicating information to patients and their families physicians are often expected to understand the illness fully (omniscience), to have implemented the correct solution to the problem (omnipotence) and to be able to determine in advance what the outcome will be (precognition).

Gee, the last time I checked there was only one individual with all three of those powers and it wasn’t that dude with the red cape and the big “S” on his chest, let alone a humble doctor. Asking physicians to summon more powers than they were endowed with leads to this dilemma - should they play along with this role of a lifetime, or admit that they are less than perfect, thereby exposing themselves to the scorn of the anxious assembled all around them?

Let’s consider the options. We could choose to react to pointed or hostile questions that we haven’t a clue what the answer is like a gang of bandits cornered in a warehouse, firing back in anger. This manuever has about as much a chance of winning over the crowd as shouting “Heil Hitler!” during the playing of the national anthem before the start of a WWE match. Getting all defensive about the fact that despite treatment grandpa isn’t recovering from his brain metastases doesn’t strike me as a judicious let alone constructive use of one’s skills and energy. Then there’s always the “I don’t know” angle, whereby we assume a pose of mystical, Gandhi-like quiescence and look off toward some distant peak as we confess the limitations of humanity. This certainly might get one off the hook but does not exactly inspire confidence in our leadership of the crisis.

Therefore, when faced with a touchy situation or a clinical mystery that has us stumped, we bearers of the caduceus sometimes resort to circumlocution, to perphrasis, to taking evasive action like a submarine diving beneath the thermocline to escape a Russian torpedo. As a Method actor might say during rehearsals, “What’s my motive for this behavior?” Here’s what the director might say:

“You’re trying to avoid a confrontation. Doctors in general do not like to get into fights with their clients.”

“You’re desperately trying to focus on the good news; for example just think of all the money she’ll save on groceries by losing her appetite.”

“You’re afraid of being labeled an insensitive louse by the patient’s heavily tattooed family.”

“You’ve convinced yourself that your patient will improve despite any setbacks such as the fact that she just died.”

I know it has been said before, but let me repeat it for all: doctors have to learn to become good actors if they ever want their practice to flourish. The truth, aside from being something in the movies that folks are accused of not being able to handle, hurts when it is composed of unfortunate news. Sometimes doctors have to provide counseling in such a manner as to not create a wailing morass of distraught relatives who become a whirling dervish of misinformation and despair. You may call it tergiversation, but we pros call it diplomacy. Think of it as that old joke about the fellow who said, “Don’t just come out and tell me our cat died! For Pete’s sake break it to me easy - say that the cat is on the roof, and then the next day say it won’t come down, and the next day say it slipped and fell onto the rocks! By the way, where’s Grandma?”

“She’s up on the roof.”