If the reactions between the patient and the doctor are to be studied as a way of illuminating the patient’s problem, it is necessary for the doctor to be aware of his or her normal doctoring style. It is then possible to recognize changes from this norm, and to think about what it is in [...]
Marital therapists, or couple therapists, work with the couple on the relationship between them. Referral for marital therapy will be more effective when there is agreement between the couple that changes in the relationship are required. Specific training in sexual difficulties is taken by selected therapists who work for Relate Marriage Guidance, or facilities may [...]
Patients in the older group may have anxieties about whether they should be still sexually active and hide their requests for advice about contraception behind other complaints such as vaginal soreness or period problems in the same way as those just beginning their sexual life. They may need to try out a different doctor from [...]
Serious marital or sexual problems are unlikely to be improved by sterilization of either partner, and one of the most important tasks of the pre-sterilization consultation is to identify the hopes and expectations of the couple. Not infrequently the man may hope that it will make his wife more interested in sex. One man blamed [...]
This chapter is written from the point of view of doctors working in Britain with patients from other cultures, rather than about doctors who work abroad. This author’s experience as a general practitioner working with recent immigrants in Tower Hamlets, a deprived inner city area of London, will illustrate the most obvious problems of cultural [...]
Most people feel okay for several hours following chemotherapy treatments; they are able to eat, work, do errands, and so forth. Usually some reaction occurs four to six hours later; there are some people who experience little reaction until twenty-four or even forty-eight hours later. On the other hand, some people feel the worst twelve [...]
An annoying complication of axillary dissection (done either with mastectomy or lumpectomy) is lymphedema of the arm. Lymphedema is chronic swelling of the arm due to the accumulation of fluid as a result of lymph node surgery. This surgery can interfere with normal drainage. Lymphedema occurs very rarely following the limited type of axillary dissection [...]
The impact of your cancer on your grown children will be significant. Frequently young adult children—that is to say, those college age or slightly older—may seem quite unconcerned about your diagnosis. This is usually perplexing and even hurtful to the mother, but it may help to know that it is normal. Their apparent nonchalance masks [...]
The reality of medicine today is that you may not spend even a single night in the hospital throughout your breast cancer experience. We have even heard of women being discharged on the same day that they have undergone mastectomies. If you know that you are not feeling well enough to go home, say so [...]
David Spiegel, a psychiatrist at Stanford University, published an important study in 1989 about the positive effect of support groups on the longevity of women with breast cancer. Although his groups were all for women who had metastatic breast cancer, he found that those women who were in support groups lived longer than those who [...]