Skepticism of health care is often common in vulnerable populations. M3 Lauren Offield shares her encounter with an elderly patient skeptical of a cancer diagnosis due to past health care letdowns–and reminds future physicians to recognize systemic challenges and understand patients holistically. This article first appeared in in-Training, an online publication for and by medical students.
During my family medicine clerkship at a local community care clinic, I encountered a multitude of distinctive patient experiences. Here, I worked alongside physicians to provide free healthcare to the uninsured and underserved members of the South Florida community. These experiences will remain with me throughout my training as a medical student, resident and as an attending physician. I had the opportunity to engage and build connections with patients stemming from diverse cultural and ethnic backgrounds. Skepticism of healthcare is widespread throughout some of these communities — rightly so due to historical mistreatment, discrimination and lack of representation along with cultural differences. This distrust may be further strengthened by a patient’s own personal experiences. I respected this wariness, but I had yet to witness it firsthand.
The raindrops tapping against the roof of the building were audible as my attending physician and I walked into the dimly lit exam room. An elderly Indian woman glanced up at us, her hands gripped tightly onto the walker that sat in front of her. She appeared preoccupied, but quickly glanced in our direction and greeted us with a warm hello. She was there for a follow-up visit after being seen in the emergency department complaining of vaginal bleeding. Knowing that postmenopausal vaginal bleeding could indicate malignancy, I was worried for her.
Almost immediately, she began to explain that she was told she had cancer. “I do not believe it,” she declared. She went on to describe the way her body felt; she had a genuine sense that she did not have cancer. She did not feel sick, and it had been days since she had bled.
Due to her previous experiences with the healthcare system, she harbored doubts about the truthfulness of her diagnosis. She exclaimed, “They just want to remove another organ from me!” They advised her that the most appropriate course of action was to undergo a hysterectomy. Upon further questioning, she detailed an account that occurred years ago when she experienced unrelenting abdominal pain. She sought care at the same hospital that had just given her a cancer diagnosis. They told her she needed a cholecystectomy and reluctantly, she agreed. However, her symptoms did not resolve following the surgery, and she still did not know the cause of her recurrent abdominal issues.
My attending excused herself to attempt to contact the emergency department and obtain the patient’s medical records while I continued speaking with the patient. I asked her how she was feeling. Initially, I sensed a guarded demeanor, and it was evident that she was reluctant to open up to me. I did my best to convey a tone devoid of judgment, aiming to create an environment where she could feel at ease. Slowly, I could feel her becoming less apprehensive. The room got a bit lighter. With tears filling her eyes, she expressed her worries to me at length. It seemed as though she did not have much, if any, support. It is just her and her son here in the United States, and she did not feel comfortable talking to him about all of this. “He has his own worries,” she explained. Among other issues, finances were a major concern for them both. She was also concerned about the potential consequences for herself if anything were to occur to her son because he was her primary caretaker. She was riddled with anxiety. My heart broke for her. I know that feeling — the feeling as if you are being engulfed by an overwhelming sense of worry. I wanted to reach out and give her a hug. This patient felt completely alone and was informed she had cancer by an entity she did not particularly trust.
She put most of her faith in prayer and astrology. That gives her hope. I listened and learned. I often find it challenging to grasp the intricacies of both religion and astrology. However, I knew at that moment this is what helps her cope with her emotions, and that is all I had to understand.
After obtaining the patient’s medical records, it was confirmed that she did in fact have stage 2 endometrial adenocarcinoma. We discussed with her the potential risks of delaying care and strongly advised her to follow up with oncology. She was adamant about getting a second opinion, though her options were limited due to financial constraints. Sadly, she never returned to the community care clinic. As such, I am uncertain if she received follow-up care, but I would like to hope that she did.
I would also like to hope she is aware of the impact she had on me. Her story serves as a powerful reminder of the systemic challenges within healthcare and the importance of understanding each patient’s life beyond their medical diagnosis. This patient has and will continue to influence my approach to patient care, reinforcing the need for empathy, cultural sensitivity, and a holistic understanding of the individual beyond their medical condition.