By Joanna Hathaway, MPH

I believe it was Kate Pickert’s Radical where I learned the phrase “Straight-A cancer patient” and it resonated immediately. The Straight-A cancer patient is lovely to work with: she wants her whole medical team to like her so she listens well, is compliant with medical advice, and avoids making a challenge or, god forbid, a scene.  She might accept appointments that don’t work with her schedule, nod and smile at terminology she doesn’t understand, and schedule a lab visit for which she has no idea of the reason.  Yes, of course: Straight-A cancer patients can be male, but I work with breast cancer patients, so most of my valedictorians are female.

While some Straight-A cancer patients are undoubtedly high-achieving pleasers in the rest of their lives, I strongly suspect some patients take on those pliant characteristics in the face of something scary and unknown. Perhaps fear brings deference? Perhaps there is a subconscious belief that being as “good” as possible improves chances of a smooth recovery? Perhaps nurses will be kinder to deferential patients when they are trying to find a vein to tap for an IV? My heart always, always goes out to the Straight-A cancer patients: these impulses feel natural and I suspect I would do the same. However, there can be a downside to being so agreeable. You might not get what you want, which can quietly brew distrust, anger, and resentment. Cancer is hard enough already.

While I encourage polite kindness to your medical team—after all, I am part of your medical team—being polite doesn’t mean you can’t have opinions of your own, advocate for yourself, and have honest and challenging conversations with your providers. Your own participation in treatment decisions will improve your care, your trust in your team, and your overall experience. Remember that while doctors know cancer better than you, you are the expert on yourself and your body.

Here’s some things to remember:

• It’s not rude to get a second opinion. It’s part of the process and most doctors see it as standard. Many second opinion doctors will offer the exact same treatment plan, but spending additional time may give you better understanding of your diagnosis and treatment, and also see how different personalities will approach the same situation. I encourage you to ask your doctor how to get a second opinion, but if that feels too uncomfortable—call your insurance provider to direct you.

• You can have a good relationship with your doctor and still disagree with them. If they will not make an accommodation that you ask for, there is certainly a reason—which might be medical, ethical, legal, or something else. Feel free to ask what that reason is. You deserve to know in terms you understand. This does not have to be a contentious conversation: you can work together to problem solve an issue, when you both understand each other’s parameters.

• Educating yourself on the vocabulary and medical science will give you more confidence at your appointments. It’s helpful to know a little. But you don’t have to know everything. It’s perfectly ok to ask your doctor to explain his or her medical opinions, especially if they differ from your gut feeling.

• If you want to go a different route than your doctor recommends, it is valuable to ask him or her what the risks of doing so are and if they can be quantified, and provides a constructive way to frame a conversation that might hold disagreement.

• Your medical provider might have a person designated to help you maneuver the tangle of cancer care and help you through difficulties you might experience. Oftentimes, that person is called a patient advocate, patient navigator, care coordinator, or social worker. Ask if that role exists—that person is there to answer questions when you don’t have access to or agreement with your doctor.

• As well as emotional comfort, cancer support groups are a very practical way to learn methods to navigate medical care and learn about the resources available. Look for what is available in your area—you can reach out to the American Cancer Society to learn more if support group resources in your area aren’t obvious.

Mostly, remember, there are no rewards for being a Straight-A cancer patient—but the rewards for getting through treatment in a way that feels comfortable, safe, and aligned with what feels right to you are huge.

Joanna Hathaway, MPH

I facilitate cancer support groups at Kaiser Permanente San Rafael, and am so grateful for all the wise patients I learn from. Many of KPs support services are open to patients outside of the Kaiser network. Please don’t hesitate to reach out with questions, comments, or for support.  joanna.s.hathaway@kp.org