The Power of Human Connection: A Surgeon's Perspective on Communication, Empathy, and Patient-Centered Care

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Coming up on this episode of the
Healthy, Wealthy Wise podcast.

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The ultrasound can tell you whether
the lump that you feel in your breast

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is filled with fluid or if it's solid.

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Why is that important?

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Welcome to the Healthy,
Wealthy Wise podcast with Dr.

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William T.

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Choctaw, MD, JD.

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This podcast will provide you with
tools and actionable information

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you can use to help live a more
healthy, wealthy, and wise life.

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It's powered by By the over 50 years of
medical experience of this Yale University

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Medical School trained surgeon who is
also a Western State Law School trained

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attorney with executive experience being
a former mayor of Walnut, California,

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as well as the current chairman of the
nonprofit Servants Arms and as president

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of Choctaw Medical Group, Incorporated.

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This is the Leadership Masterclass
Edition, already in progress.

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Ways to lower your breast cancer,
um, uh, uh, number one, uh, is to

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examine your breasts regularly.

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Uh, have your regular mammograms
and again, talk to your doctor

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in terms of based on your age and
healthcare, uh, history, how soon

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you should get a screening mammogram.

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Um, um, and that, that those
have to decrease your risk.

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Well, when should you call a doctor?

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Well, I would say whenever you
feel a lump, you should go and

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have that evaluated by a physician.

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Because you don't know what the lump is.

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Uh, and so, you need to then have an
evaluation to decide what that lump is.

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Other signs of the breast when you
evaluate your breast are, again,

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if you feel something in your
breast, take a look at your breast.

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Is there a different color of your breast?

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Is there an area that looks different
from the way it last looked?

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Does the nipple look normal?

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Is part of the nipple inverted or changed?

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All those changes of the breast could
be exemplary of some form of breast

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abnormality like breast cancer.

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So, one of the things that increase
your risk as a woman, and I'm going

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to stick with women right now, of
developing breast cancer, well, age, age.

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If you're getting older, and I'm
going to say your risk of breast

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cancer at 60 is greater than
your risk of breast cancer at 30.

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Because what we know is that as we get
older, the breast cancer risk increases.

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Second point, being female increases
your risk of developing breast cancer.

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Now, let me quickly add,
men also get breast cancer.

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Men get breast cancer.

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It's not as common, obviously, uh, but
it does happen and, and I've seen it,

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when men get it, it's usually worse.

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And one of the reasons it's usually
worse because men tend to wait, you

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know, they tend to say, no, this, this
can't be anything important for me, you

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know, blah, blah, blah, blah, blah, blah.

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So breast cancer is not
singularly a female problem.

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It is not.

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And it's important to keep that in mind.

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But the majority of the people who get
breast cancer are women and that's where

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we'll have most of our discussion today.

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Um, uh, and so that is something
you want to be concerned about.

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If you have very dense, um, uh, breast
tissue, you have very large breasts.

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Many times you can get breast cancer
because a lot of times individuals with

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very large breasts, it's hard to examine
the breasts carefully and critically.

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If you've had previous breast
cancer, obviously that increases

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your risk of having breast cancer.

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Um, different ethnic groups, um,
Caucasian women have a higher incidence

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of breast cancer than non Caucasian women.

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Um, uh, but non Caucasian women
have a higher risk of death from

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breast cancer than Caucasian women.

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And the belief is that, uh, non Caucasian
women may wait longer, there may be

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financial reasons, there may be insurance
reasons, et cetera, et cetera, but, but

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those with some of the numbers show.

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If you've had radiation therapy
for some other problem, that

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might increase your risk.

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for breast cancer.

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Uh, again, if you had children and
you did not breastfeed, that might

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increase your risk for breast cancer.

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If you drink, some studies have
suggested that might increase your risk

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and something called the BRCA gene.

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And we'll talk about that
later on as, as, as we go.

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Oh, again, let's, let's go
over what, what are the tests

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you've examined your breasts.

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Let's say you feel something.

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You go in and see your doctor.

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He says, okay, I want to get some
blood tests and I want to, I don't

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want you to have a mammogram.

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Sometimes your doctor may
suggest an ultrasound.

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Well, what's the difference between
an ultrasound and a mammogram?

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The mammogram is more specific.

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But the ultrasound is unique in that
the ultrasound can tell you whether the

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lump is a cyst or whether it's solid.

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Think about that.

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The ultrasound can tell you whether
the lump that you feel in your breast

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is filled with fluid or if it's solid.

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Why is that important?

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Because chances are, if it's filled with
fluid, it's a cyst, and it's benign.

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It's not a cancer.

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Okay?

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Uh, and if it's solid, it's more
likely, um, uh, to be a cancer

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than if it has fluid in it.

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Uh, the doctor may order an MRI, which
can give an even more specific diagnosis.

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type of exam, um, or a diagnostic
test of what that lump is.

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So again, if one were to look at
a mammogram, you can't really,

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the average person can't really
look at a mammogram and tell you

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a 50 millimeter lump is there.

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And if it's there, uh, whether, whether
that lump is, is a cancer or not.

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On the screen now is a
picture of a mammogram.

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If you were able to see this.

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Um, um, one of the ways, and
last year we did a whole master

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class on artificial intelligence.

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Well, artificial intelligence is
growing in, in healthcare like wildfire.

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And one of the areas of artificial
intelligence, another area that

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is beneficial is in radiology.

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Think about it.

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Radiologists basically look at an x ray.

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They look at a fem, and they may use
a magnifying glass or whatever, but

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they look for certain distortions
and changes on that film to decide

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whether that's significant or not.

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Um, you can do an algorithm with the,
um, um, uh, with, with, with, uh, the

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advanced knowledge of, of today's.

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Uh, uh, mammogram, uh, and other
types of, of tests, uh, and with the

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artificial intelligence and the A.

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I.

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can tell you instantly whether
that's, um, an abnormality or not.

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The A.

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I.

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is just faster and smarter,
basically, than we humans.

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And certainly one of the
places is in radiology.

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Uh, again, Diagnosis, exam your
breast, examination of your breast,

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mammogram, ultrasound, um, uh,
basically blood test, possible MRI.

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Well, what about, what is
treatment for the breast lump?

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Without a doubt, there's nothing
more discomforting for a patient than

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for her doctor to say, We're going
to need to send you to a surgeon,

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uh, being a surgeon, nobody, nobody,
nobody wants to come to see me.

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You do not want to go see a surgeon.

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This old doctor can send me anywhere,
but don't, don't send me to a surgeon.

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I can tell you, I can
tell you, and trust me.

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I have been on both sides of that.

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I've been both patient and doctor, so I,
I, I understand it from both perspectives.

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But one of the things that I would
do in, in my practice, um, is I

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would always keep that in mind.

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Um, I would try to always be respectful.

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I, I would try to always slow down, uh,
in what I'm saying and how I'm saying it.

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And I would try to, um, as
some people say, read the room.

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And what, what do I mean
by reading the room?

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Um, I believe that most
communication is non verbal.

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Now, we talk all the time, and
we talk back and forth, and

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blah, blah, blah, blah, blah.

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I believe that often, many times, the
words get in the way of communication.

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Get in the way.

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If you doubt that, you go
and just sit in an audience.

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Church, don't say anything,
just sit, and listen, and look.

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And you'll learn all
sorts of things, right?

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Uh, uh, and, and you'll learn a lot.

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Uh, but you don't have to talk, you
don't have to put your words out there.

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What, what's my point?

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My point is that what I try to do
is to understand the communication

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that my patient has given me when she
walks into the door, through the door.

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I'm terrified of you, I'm scared of you, I
don't trust you, I don't know what's going

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to happen, I think I'm going to die, on
and on and on and on and on and on and on.

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And then I, you know, have her to
take a seat and then I say, okay,

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let's, let's, let's, let's, let's,
let's go down your list one at a time.

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And I tell myself, I take as much
time as I need, um, and, um, that's

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really, I think what's important
in terms of patients who have

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even the possibility of a cancer.

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When you mentioned the C words.

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Most patients, many patients,
don't hear anything else you say.

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You can talk for an hour.

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All they heard is you
said they had cancer.

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And they're saying, oh my god,
blah, blah, blah, blah, blah, blah.

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So, when they come to see the surgeon,
they come to see us and come to see me

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because they need some type of surgery.

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So what type of surgery do we do?

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with, with individuals with,
with, uh, cancer, breast cancer.

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There are two main types early on.

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One is called a biopsy.

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Well, what is a biopsy?

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Again, let's go back to the law.

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We have a law.

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A biopsy means I take a piece of the law.

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I don't take the whole law.

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I take a piece of the law.

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If I do an excision or I excise the
law, it means I take out the whole law.

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Okay.

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Biopsy means you take a piece of something
excision means you remove the whole thing.

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So my goal is always to
remove the whole law, right?

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I always want to remove the whole thing.

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Why?

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Because if, if someone has a love and
you take a piece of it, how do you know?

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that what you took is cancerous, more
importantly, how do you know that what

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you left behind is not cancerous, right?

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So ideally, if possible, you want to
take out the whole lump, and not only

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do we want to take out the whole lump,
we want to take out the whole lump

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with the margin of normal tissue around
us, around it, because that's how

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you know you removed the whole lump.

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So we call that an excisional biopsy.

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Now, if you remember what I said earlier,
that most of the times, most patients are

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not able to feel a lump in their breast,
even when they have one, because the

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lump is too small, which is a good thing.

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And that's why the mammogram
is so important, because the

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mammogram can show you lumps.

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that are too small for you to feel.

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So then you said, but then
doctor, you were just telling

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me how you remove the lump.

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How do you do that?

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Well, uh, when the radiologist does
the mammogram, uh, and identifies the

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lump, he then puts a little band needle.

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under x ray all the way down to the lump.

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He injects a dye through that needle,
a little blue dye around the lump.

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And what he is doing, he is creating
a roadmap for me or any other surgeon

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to be able to know where the lump is
and to be able to size the whole lump.

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So it's, it is a delicate process.

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Um, I, I say all the time about
the importance of relationships,

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that surgeon radiology
relationship is really important.

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You know, because I'm saying blah,
blah, blah, and he's saying blah, blah,

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blah, and she's saying this and that.

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But that's how we remove the lumps.

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That's how we remove them.

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And that works well over 98,
99 percent of the time, okay?

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Fortunately, most people, most of the
time, the lumps are not cancerous.

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Most of the time, the
lumps are not cancerous.

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So, we've talked about excising
the lump, we've talked about

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the presence of the lump.

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Um, what about spread of the cancer?

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One of the reasons why we surgeons
want to get that cancer out as fast as

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possible is we don't want it to spread.

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Why is that?

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Because once the cancer spreads, It's
a whole different ballgame in terms

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of treatment and in terms of condition
and in terms of survival, right?

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Once that lump is localized, the
cancer is localized, treatment and

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eradication of the cancer is much easier.

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Once it spreads to the lungs or to
the bones or to the brain, uh, then

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it's a whole different ballgame.

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And now you're talking about radiation,
you're talking about chemotherapy.

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So the smaller the lump is,
the more localized the lump is.

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the better the prognosis
is for the patient.

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What are the main types of surgery
other than excisal valve that we

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do as, as breast cancer surgeons?

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Well, one procedure we do
is called a mastectomy.

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Mast meaning breast,
ectomy meaning removal of.

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So, mastectomy is removal
of the entire breast.

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Removal of the entire breast.

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Mastectomy can be either a modified
radical mastectomy or radical mastectomy.

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What's the difference?

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A modified radical mastectomy means I
remove the entire breast plus lymph nodes.

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A mod, a radical, that's
a modified radical.

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A radical mastectomy.

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Mastectomy means I remove
the entire breast and muscle.

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No one does, hopefully, radical
mastectomies anymore, hopefully,

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uh, because studies now show that
there's not a great deal of difference

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between doing a modified radical
and doing a radical mastectomy.

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In other words, in general,
there's not a good reason to

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remove the muscle and the breast.

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You just remove the breast, okay?

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Now, as you might imagine,
removing the breast is a big deal.

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Not only is it a big deal
physically, it's a big deal mentally.

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It's a big deal psychologically.

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Um, and I've, I've, I've gone through this
with certainly over a hundred patients.

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Uh, and again, everybody's
a little different.

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Everybody's a little different.

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Some patients don't care.

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Say, I don't care.

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Take it.

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I, I, no problem for me.

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Um, other patients, it is, it is,
it is like their world, basically.

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And so then a decision has to be made.

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Decision has to be made.

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Um, as a physician, my
role is to give the facts.

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Pro and con.

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Um, Physicians have a duty to inform,
patients have a right to refuse.

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Physicians have a duty to inform,
patients have a right to refuse.

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The majority of patients, my
experience, 95 plus, will follow

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whatever the physician says.

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Basically, um, so those are the, so
we're talking about the lumpectomy

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where you excise the lump, remove
the entire lump, um, um, if, uh, the

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lump is removed, is cancerous and the
cancerous is an invasive type of cancer.

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And what do I mean by an invasive cancer?

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It's a cancer that is growing beyond
the margins of border of the lung.

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That's considered invasive.

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It is invading.

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It is moving, if you will, as compared
to a cancer that's in situ, that's

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sitting, it's not moving, sitting cancers.

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You can remove them in their
entirety and you don't have to

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do anything else in general.

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Uh, invasive cancers are the ones
where you look at doing possibly

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a mastectomy or something more
than just removing the lung.

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for listening to the Healthy,
Wealthy, and Wise podcast with Dr.

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00:17:20,405 --> 00:17:20,944
William T.

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Choctaw, MDJD.

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00:17:27,734 --> 00:17:32,285
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00:17:32,355 --> 00:17:33,135
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Be sure to follow, like, share and
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00:17:49,965 --> 00:17:54,234
tune in for the next episode of the
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00:17:54,234 --> 00:17:54,785
William T.

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Choctaw, MD, JD, and Dr.

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00:17:55,726 --> 00:17:55,911
William T.

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00:17:55,911 --> 00:17:56,097
Choctaw, MD.

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00:17:56,097 --> 00:17:57,303
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