It is a common assumption in healthcare that patients look to physicians for conversation and understanding, while turning to surgeons for decisive action. However, a compelling new study and expert reflections from within the medical community are challenging this outdated divide, highlighting a growing patient demand for holistic care from all specialists.
The Communication Gap in the Operating Theatre
Australian oncologist and author Ranjana Srivastava recently highlighted a telling encounter with a surgical colleague. They were discussing a complex, high-risk operation for an elderly cancer patient. The plan involved significant physical trauma and potential long-term complications. When Srivastava asked, "What does the patient want?" the surgeon's response was telling: "She wants to live. Isn't that what everyone wants?"
This moment underscored a critical information asymmetry. The patient had spent nearly an hour with her oncologist exploring her values and desire for quality of life over aggressive intervention. Yet, this nuanced conversation had not translated to the surgical plan. It revealed how different specialists can form substantially different treatment plans based on the fragments of a patient's story they each hear.
What Modern Patients Actually Expect
Contrary to the old stereotype of the technically brilliant but emotionally detached surgeon, contemporary patients have clear and broader expectations. Recent research provides a blueprint for what they seek:
Patients deeply value surgeons who offer emotional support and optimism, skillfully balancing hard facts with genuine empathy. They want discussions that go beyond the procedure itself to address the long-term impact on their quality of life. The use of clear decision aids, graphics, and plain language is also highly appreciated.
While some patients prefer to defer to their surgeon's expertise, many now actively seek shared decision-making. This process artfully blends professional medical knowledge with profound respect for the patient's personal values and life goals. Furthermore, patients are increasingly aware that the best cancer care comes from a multidisciplinary team. Adding nurses, allied health professionals, social workers, and dietitians to the conversation ensures the whole person is treated, not just the disease.
The Delicate Art of Discussing Prognosis
One of the most challenging areas remains discussing prognosis. Most patients want to know the statistics—their survival odds compared to others. However, the human body's unpredictability makes this intensely difficult. Complicating matters further, patients often want to hear good news but may shy away from the bad.
For instance, a surgeon can confidently share the high cure rates for early-stage cancers. But for advanced disease, the prognosis is more guarded and depends on complex factors like molecular markers. This discussion often requires an oncologist's nuanced understanding of drug therapies, side effects, and risk-benefit trade-offs. A well-intentioned surgeon can quickly find themselves in unfamiliar territory, highlighting the need for close teamwork.
As Srivastava notes, one of the hardest parts of being an oncologist is hearing patients' delayed disappointment about conversations held when they were most vulnerable. "It is an opportunity lost," she writes.
Raising Expectations for the Future of Surgery
The call is clear: while society rightly holds surgeons in awe for their gruelling training and technical mastery, patients also need them to be approachable communicators. The study reinforces the urgent need to raise expectations and formally train future surgeons in advanced communication skills.
In Srivastava's case, following their discussion, the surgeon revisited the elderly patient. After understanding her goals, he respected her choice to forgo the massive operation in favour of a less invasive approach. The 87-year-old patient's subsequent concern was poignant: she worried if the surgeon, half her age, was "hurt" by her decision. The reassurance was simple and powerful: the medical team was there to serve her needs, not the other way around.
This shift towards empathetic, patient-centred surgical care is not just a nicety—it is fundamental to achieving outcomes that align with what patients truly value for their lives.
