Some time ago, a judicious and considered surgeon was describing the complex operation required by our mutual cancer patient. The operation necessitated a large incision, prolonged anaesthesia and possibly a second operation. Then there were the long-term complications, including pain and disfigurement. The patient was elderly and somewhat vulnerable to begin with, so just listening to the plan filled me with consternation.

So, without telling him how to do his job, I asked politely: “What does the patient want?”

He looked at me as if I was disturbed before saying: “She wants to live. Isn’t that what everyone wants?”

His question needed no reply because I knew that he knew that, in keeping with the evidence, many of our shared elderly patients emphatically chose quality of life over longevity.

But I had reason to wonder if the patient had told the surgeon the same things she had told me over a consultation that had taken the best part of an hour. We had delved into her values, what mattered to her, and how she wanted to live the rest of her life. Living longer with the distinct possibility of a loss of independence had not been on her wishlist.

This made me reflect on the information asymmetry between what patients told their oncologist or GP, and what they told their surgeon, which leads to substantially different treatment plans, neither “wrong” but each consequential in its own way.

It has been traditionally assumed that patients expect the “listening” part of their care to........

© The Guardian