Dear Patient,
During and after cancer treatment, a common greeting-How are you? -may stir unpleasant emotions or cause confusion about how to answer. This handout offers insights and tips on responding in ways that help you. The key message is this: In medical settings, answering candidly is essential to optimizing your care.
What are healthcare professionals asking when they greet you with How are you?
A breezy How are you? while entering the room may mean nothing more than Hello. More than likely, the question marks the beginning of your medical evaluation. Your answer helps them assess how you are doing, physically and emotionally. If things are going well, an easy answer is I'm fine. Doing great. If dealing with symptoms, challenges, or losses, your best answer may not be so simple.
Why might that question trigger emotions?
At the heart of the matter is a fact: The purpose of your doctor visit is to determine the status of your cancer and other medical issues. In other words, at the start of each visit you don't know how your health is doing-and you are about to find out.
Other reasons for reacting emotionally include that maybe you...
* Don't want to complain.
* Want to be a success story and not disappoint your doctors.
* Want to appear strong to friends or family also at the visit.
* Fear that your doctors will decrease/stop treatments if you aren't fine.
If your style in social situations is to always respond with Great!, then it can be difficult to let go of that approach during doctor visits.
What if you don't know how to answer?
You are not alone. Patients describe feeling unsure about whether to give a quick overview of how they're doing physically, how they are coping emotionally, or how life is going outside of cancer.
What is the most helpful answer?
In medical settings, the best answer is one that accurately informs your healthcare team about how you are doing between visits. If dealing with symptoms and/or emotional distress, answering, Great! may jeopardize your care. How? By leading your healthcare team to underestimate the severity or impact of problems you describe later during the visit. That unintentional misunderstanding might delay useful tests or interventions.
Keep in mind:
* Doctor visits are not social visits.
* Talking about symptoms is not complaining but reporting vital information we want and need.
* You play a vital role in optimizing the outcome by keeping your healthcare team informed about problems, no matter how seemingly minor-even if doing so makes you uncomfortable.
How can you minimize the stress or discomfort of answering honestly?
Prepare your answer ahead of time so you don't have to think about it in the moment. If you are managing ongoing symptoms, stresses or losses, examples of honest-yet-upbeat answers include:
* Hanging in there. Not well, but good enough.
* As well as can be under the circumstances.
* Good, all things considered...and there's a lot to consider.
If distressed, honest-yet-upbeat answers include:
* I'm trying to hang in there.
* I'm hoping this visit will help.
* It's been rough, and I'm ready for whatever we need to do next.
An option is interpreting How are you? as a social greeting and responding with a comment about the weather or an upcoming event (i.e., unrelated to your health). That approach is fine if-and only if-throughout the rest of the visit you accurately and thoroughly report how you are doing.
Why might some patients feel sad after a doctor visit?
Patients sometimes experience a brief bout of post-visit blues, even if the checkup had no disappointing or upsetting news. Cancer-related symptoms and stresses are still a sad reality for patients who have adjusted well and are generally happy. Remind yourself that you did the right thing by reporting your symptoms honestly. Any visit-associated emotions should resolve soon after resuming your usual routines. If not, please let us know.
What if friends, family, acquaintances, or strangers ask How are you?
After cancer, casual interactions (e.g., with a cashier) and meetings with friends and family often begin with the question How are you? In contrast to medical settings, your responsibilities are different in non-medical settings, as are the consequences of answering candidly.
You may wish people didn't ask if the question:
* Reminds you of your cancer when you weren't thinking about it.
* Takes emotional energy answering even if your update is good news.
* Exacerbates a heightened sense of vulnerability, especially before a checkup.
If you're going through a rough patch, answering friends or family honestly may:
* Lead to unwanted opinion or advice about your medical care.
* Put you in a position of consoling the asker who gets upset.
* Trigger renewed grief about your situation.
Complicating matters, awkward situations arise if you start to explain what's going on before realizing the person was just saying Hello and doesn't want to talk about your health.
What is a helpful answer if you don't want to talk about your health?
In social settings, the priorities for answering How are You? are different from those in medical settings. Whether asked by a stranger or a close friend, the top priority is answering whichever way helps you.
If you don't want to talk about health, preparing an automatic response saves you emotional energy. For interactions with people not part of your personal life (e.g., store clerks; plumbers), answer whichever way works for you, no matter how inaccurate. Common responses include, Great! No complaints! Grateful. Living the good life.
With family and friends who ask (assuming not in a gathering with other people within earshot), share if you want to. If not, let them know by shutting down the health topic with something like Not great, but good enough. I'll update you later. Helpful answers preserve the close relationships that enable you to get assistance when needed, minimize hurt and misunderstandings, and express and receive love.
WENDY S. HARPHAM, MD, FACP, is an internist, cancer survivor, and author. Her books include Healing Hope-Through and Beyond Cancer, as well as Diagnosis Cancer, After Cancer, When a Parent Has Cancer, and Only 10 Seconds to Care: help and hope for Busy Clinicians. She lectures on "Healthy Survivorship" and "healing hope." As she notes on her website (http://wendyharpham.com) and her blog (http://wendyharpham.com/blog/), her mission is to help others through the synergy of science and caring.