"Diagnosis - cancer": patient care standards

In taking on the “Diagnosis - cancer” multimedia project, LTV and LSM.lv were surprised by the amount of people who mentioned communication with doctors as one of the main problems in their diagnosis and treatment process. The issues are most acute when it comes to diagnosis, as well as during discussions about further treatment for patients. No one likes presenting or hearing bad news, but communication issues plague the Latvian medical system from diagnosis, to notifying the next of kin in cases of death.

“Patient complaints and our research shows that doctor attitudes towards patients can frequently be careless, arrogant or even cynical. Patients also often truly don’t understand their treatment process or ailment. The international standard doesn’t work in Latvia.” admits LTV Journalist Odita Krenberga.

Informing Next of Kin

The “Stradiņi” hospital quality regulations include the internationally recognized SPIKES protocol for delivering bad news to a dying patient or their relatives. The acronym, which stands for Setting, Patient perception, Invitation for Information, Knowledge, Explore emotions and empathize, and Strategy and summary, provides a sequence of steps as guidelines for dealing with patients in an emotionally sensitive way.

At both of Latvia's largest hospitals - “Austrumu” and “Stradiņi” - relatives are notified about death by the treating doctor or on-duty doctor. “Stradiņi” guidelines dictate that the next of kin should be informed as soon as possible, including nighttime phone calls, unless specifically asked not to. “Austrumu” hopital doesn’t make late evening or night time phone calls.

Unfortunately such protocols aren’t always followed, or carried out in a sensitive manner. When Aivars Preiss died, his wife Larisa came to visit him in the early morning at Jelgava Hospital, not knowing that he had died. Upon finding his empty bed, she began to ask around, until finally a passing medic told her “he has passed, he isn’t here”.

“But how did no one call, no one did a thing... Well of course I sat by that bedside for half a day, I couldn’t leave and just cried. When I left everyone was laughing, everyone was joyful. Nothing happened - a person was taken to the morgue!" says wife Larisa.

Communicating the Diagnosis

The Latvian Health Economy Association (LVEA) study “Evaluation on patient flows in oncology in 2017 and 2018” data shows that half of patients surveyed admit that they don't understand anything about their examination results, and the other half says the results were “almost completely” explained.

More than half of surveyed oncology patients felt that the manner in which they were informed of their diagnosis was insensitive, or not sensitive enough. Patients frequently experience a lack of empathy, and a careless, ironic or even a snide attitude from doctors, for whom they are just the next one in line.

Not Enough Attention

Aivars Preiss died two years ago from stomach cancer. In the beginning, the Jelgava hospital didn't recognise the signs of cancer and performed an umbilical hernia surgery. When the pain didn't go away, his stomach was only partially examined and the doctor hurriedly threw out a suggestion to eat less.

When Preiss ended up at the “Gaiļezers” hospital, the cancer had developed so far that it was clear his stomach needed to be removed. No one, however, explained to him how he is supposed to live without a stomach.

Preiss' doctor has a very different recollection. “I remember this instance very well, because we received a complaint about our treatment, even though in my opinion we did a great job. I remember it well, because we thoroughly discussed the treatment process and established good contact,” says “Gaiļezers” Surgeon Igors Ivanovs.

Too Many Patients, Too Little Time

Sandra Mieme recalls regular waiting times of an hour to an hour and a half when going to see a doctor, taking her newborn with her. “I’m running running around rocking my little baby for two hours up and down the hall. I’ve been going for check-ups for two year, and they’re always an hour or two behind,” says Mieme.

Larger university hospital representatives admit that workflow and personnel workload is an issue, but that it shouldn’t affect patients. “Austrumu” Clinical University Hospital Board Chair Imants Paeglis describes cases where patients have to wait hours for a registered procedure as the exception, not the norm.

There is, however, hope on the horizon for improvement in communication and care standards. Poor patient relations may be just a legacy of Soviet times when doctors treated patients with knowledge, not personality. Professor Vladimirs Voicehovskis, who teaches medical communication at “Stradiņi” University, says that he has perceived younger doctors to be much more talkative.

The “Diagnosis - cancer” project consists of more than 200 stories from cancer patients and their relatives. Stories were gathered this year beginning from the end of spring, and Latvian Public Media would like to thank everyone who conquered their tears and fears to share their stories. The journalistic team spent several months analyzing statistics, exploring the system in Latvia, and speaking to oncologists, as well as several NGOs to draw a variety of conclusions.

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