At 47, Susan Jensen found a lump in her breast. Her doctor immediately sent her to a breast cancer surgeon, who performed three biopsies within the week. When she didn’t hear from the doctor, she assumed no news was good news. Then, the morning of her follow-up appointment, Jensen got a call while she was at work. It was a nurse from the surgeon’s office letting her know she had cancer. The nurse told Jensen the surgeon would discuss next steps later that day, during her scheduled appointment. Too shocked to muster a response, she sat on the phone in silence until the nurse broke the tension and asked how she was holding up.
“My response to her was, ‘Well, considering you just informed me I had cancer at my work, no, I’m not OK,’” Jensen, now 50, said.
For breast cancer patients like Jensen, receiving a diagnosis over the phone is an emerging trend. A new study from the University of Missouri School of Medicine found that nearly 60 percent of breast cancer patients polled between 2015 and 2017 had received the news over the phone.
Jensen thinks the practice is insensitive — she was going to see the doctor later that day anyway. Why couldn’t the news have waited?
However, the advent of online patient portals, combined with the shrinking window for how quickly doctors are expected to upload test results, could be responsible for the spike in phone-call diagnoses, says study co-author Jane McElroy, an associate professor in family and community medicine at the University of Missouri School of Medicine. “Physicians will tell me they have a 24-hour window before results are opened up to e-portals,” McElroy said. “I think physicians are reacting to the reality of what’s happening, so they get on the phone and answer immediate questions like ‘Am I going to die?’”
According to McElroy’s study results, a few factors predicted over-the-phone breast cancer diagnoses. If a patient had a strong support system, like a partner or nearby family, then they were more likely to get phone calls. Single women, the study found, were often brought into the office to receive diagnoses.
While the impersonal nature of phone-call results might turn off a lot of people, the study suggests that patients’ feelings toward the practice are nuanced. “The initial reaction is ‘That’s terrible!’ but in fact, that may not be terrible,” McElroy said. “I think there’s a cohort of people who do not want to go into the doctor’s office and hear the news.”
Some breast cancer patients who participated in the study said they would have preferred to hear the word “cancer” in a private place first, and then to have spoken with a doctor. Others felt a phone call was best. One participant said they would have liked results via email.
Michelle Urke, 51, was in the car with her husband when her doctor called her on a Friday night. She’d had her biopsy that Tuesday with a nurse navigator, a healthcare professional who advocates for patients by answering questions and explaining procedures, and serves as a liaison between any other healthcare team members. The nurse navigator told Urke she’d be out of the office for the rest of the week. But it was Urke’s primary care physician on the other end of the line. “She didn’t ask, ‘Was this a good time? Are you in a good place to hear this?’” Urke said. “She had to get this information out.”
Five years removed from her diagnosis, Urke is a mentor to other women with breast cancer, helping them navigate the whole process, from coping with their diagnosis through recovery. Having first-hand experience with the minutiae of treatment, she understands why doctors would dial up patients to deliver bad news: They’re a bit desensitized, but not unfeeling.
“As a mentor, all of this stuff is very familiar to me now,” Urke said. “But a person going into it doesn’t know what any of this is. I can see how a doctor or nurse who’s immersed in it would forget that.”
Quyen Ngo-Metzger, a physician and scientific director of the U.S. Preventive Services Task Force Program at the U.S. Department of Health and Human Services, agrees: “We deal with these type of things all the time, but for the patient, being given this kind of diagnosis has a life-changing effect.”
During medical school, doctors are trained in bedside manner, meaning the appropriate way to approach and speak with a patient. The protocol and etiquette they learn still primarily governs face-to-face interactions, but the task of delivering bad news over the phone demands different guidelines, McElroy says. She suggests the caller ask the patient if it’s a good time to talk, if they’re in a safe place and if they’d like to hear the news now or in person.
Jensen would have answered no to all of the above. Since she was at the bank where she works when she received her diagnosis, she had to field customer inquiries in the midst of a major life event. Her co-workers did the best they could to console her, she says, but they had jobs to do too. If she’d had more control over the environment where she took the call, she might have opted to get the news either at home or at her doctor’s office. The whole exchange felt “cold,” Jensen said.
“You can’t really show empathy or understanding over the phone,” Ngo-Metzger said. In her personal experience, which does not reflect the views of the government, delivering diagnostic news in person strengthens the bond of the doctor-patient relationship. It also gives the patient time to ask questions and prevents miscommunication. Patients are more likely to misinterpret information when speaking over the phone, she said.
Ngo-Metzger says team-based care, a growing practice involving collaboration between at least two healthcare providers who work with a patient, can lessen the risk of impersonal communication. If a doctor is not on hand to deliver news, then a nurse, social worker or patient navigator can handle in-person conversations. This system encourages more face-to-face, compassionate care. “That’s why we go into medicine, to help people,” she said, “not just to do the bureaucratic things that need to be done.”