Intended for healthcare professionals

Practice What Your Patient is Thinking

Get to know me as a person, not just my body parts

BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o247 (Published 23 March 2022) Cite this as: BMJ 2022;376:o247
  1. Sarah Woolf
  1. sarahannwoolf{at}gmail.com

Sarah Woolf shares the impact her cancer treatment had on her mental health and describes why it is important to see each patient as a whole person, understanding that their body has meaning for them

In 2018 I was diagnosed with breast cancer. Over many months I received chemotherapy, surgery, and radiotherapy. While my head knew this was a treatment to cure me, my body was painfully aware that it was being poisoned, cut, and burned. I was left with debilitating fatigue. I felt I was being put through a washing machine, coming out a different shape, and I became a shadow of the person I used to be.

I started to notice a link between my body’s ability to function and my mental health. I had always relied on my physical health to be active, work, and do things that helped me define my identity. Due to the impact of my treatment I had to give these up. I felt like a “no body” and became depressed, grieving for the loss of the person I had been. No one seemed to understand this.

Making things worse

While staff generally treated me kindly, the focus was on a physical cure or treatment. During more than 100 appointments, including mammograms, examinations, and radiotherapy, I was asked to stand, sit, or lie with my breasts exposed. A member of the healthcare team then manipulated my breast mechanically, as if it were an object. Very personal parts of my anatomy received a barrage of physical treatments by people who hadn’t got to know me as a person.

I felt my body was treated like a car whose mechanical parts were being tinkered with. During radiotherapy, the nurses even used my body as a table to put their notes on, as if it wasn’t part of me as a person at all. I felt invisible. I wanted them to be aware that my body has meaning for me and that the way I was being treated had an impact on me and my life outside the hospital.

Working in partnership

After about six months of treatment, I started to see the same health professional, and had a better sense of continuity. We started to get to know each other and to build more of a relationship. They found out a little about my home life and work. At each appointment they asked me how I was, and really listened to me. I felt a little more believed, as the expert on my own body, and more involved in making decisions about my treatment.

I wish that throughout my treatment my healthcare team had asked open ended questions, particularly about how the impact of treatment on my body was changing how I was feeling about myself in my life at home and within my relationships. I also think it would have been useful to have some information about this in my notes, so they could follow up on it in future appointments. This would have helped me feel listened to and empowered to make decisions together with my team. Finally, I hope that health professionals are aware that their humanity is as important as their medical knowledge. This will help patients to get well mentally and emotionally, as well as physically.

What you need to know

  • Physical and mental health are intertwined, and should be considered together

  • Understand that every part of a patient’s body has meaning for them as a whole person

  • Explore how a physical health condition is affecting a patient’s life and identity

Education into practice

  • What can you do to understand how each part of a patient’s body holds meaning for them as a whole person?

  • How could you ask a patient about how their treatment or illness might be affecting their daily life?

  • How can you work in partnership with each patient to develop an empowering relationship between you?

Footnotes

  • Competing interests: none.