What can lung cancer patients do if they feel dismissed by their healthcare provider? Dr. Narjust Florez of Dana-Farber Brigham Cancer Center and Harvard Medical School discusses research on women with lung cancer and shares practical strategies for communicating symptoms clearly, navigating bias, engaging in productive dialogue with doctors, and advocating for care that leads to accurate diagnosis and appropriate treatment.
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Transcript
Deandre White:
Dr. Florez, you’ve spoken about how women, younger adults, and people of color facing lung cancer are sometimes misdiagnosed or not taken seriously at first. So when patients feel dismissed, many don’t know how to respond and some may feel pressure to raise their voice or escalate, which can unintentionally make communication even harder.
So what approaches do you recommend to help patients maintain an open, calm dialogue while still making sure their concerns are heard and understood? And what practical steps can patients take, such as preparing their symptoms or explaining their symptoms more clearly, using strong but respectful language, and asking about the doctor’s thinking, or bringing an advocate to redirect the conversation so their needs are addressed?
Dr. Narjust Florez:
This is actually very common, so we did a study at Dana-Farber with Mass General Hospital for women diagnosed with lung cancer, and we found many of them were there, their symptoms were misattributed to anxiety, when the fact was a 7 centimeter mass. So here we have to talk about intersectionality to understand a little bit how identities intersect and negatively affect patients. So if you’re a woman of color, you are the group that you are less likely to be heard. And many of these women will have a negative experience before their cancer diagnosis. This is not the first time they have been ignored by the healthcare system.
However, my recommendation is to have clear definition of the symptoms. Come prepared, write down what is really happening, and how much is affecting your quality of life in your daily life.
See, for example, you say, oh, I’m short of breath. It’s very different than when you say, I’m short of breath when I’m taking a shower, right? What is more impactful, right? So, I have chest pain here and there versus I wake up because of chest pain. So, it’s very important that we provide…and I don’t like to put things on patients. I think as a doctor, it’s our role to diagnose patients. It’s our duty. However, I cannot change the entire healthcare system, yet.
So, having clear communication and being calm. And another thing that really helps is you ask your doctor, what do you think is happening, right? So it becomes a dialogue. A dialogue is very key. Often we feel that especially now, with all these ways of technology, that if we raise our voice and we say words like, we’re going to use legal action, actually will help us. But the fact is that research has shown the opposite.
To stop a behavior generates unconscious bias, raises unconscious bias, and for us, women of color, we get labeled as the angry woman right away. The anxious woman right away. So we need to play, unfortunately, with what we have. So come with very defined with symptoms. And if you think your doctor is not listening to you, find a new one, and there is no personal feelings that nobody’s going to get hurt, it’s your health.
Find a new doctor. I tell my patients, if you think this is not a good match, you need to trust your oncologist. Find a new doctor or go to a second opinion and see maybe that style works better for you, because this is your life, this is your health, and there are high levels of stress. So you don’t need somebody who’s going to be gaslighting you, right? So, define symptoms. Respectful, very calm. Often come with an advocate. Because sometimes the advocate can be a good resource for you to support your symptoms, right?
So, let’s go back to the shortness of breath. I have shortness of breath, so we’re going to be more clear. I have shortness of breath when I shower. And then you bring your sister. She has shortness of breath now even getting out of the couch. I don’t know who she is now. To see the impact of the statement, how that little tip, that [ACT]IVATION tip can make a difference in how we communicate with our providers. I have been misdiagnosed myself. Oh, you’re just very anxious. So, it’s very important that you have a definition, and we stay calm. Very important.