The cancer patient: communication and morale.

Good communication in any serious or potentially serious situation is a complex and difficult art, full of paradox. Many of those who are best at it never analyse what they do, let alone write about it. Some think that the subject cannot be taught, being dependent only on personality and experience, perhaps fostered by example. As with leadership, the essence of a good relationship between doctor and patient or nurse and patient tends to evaporate as soon as any attempt is made to put it into cold print. Warmth, concern, sincerity, and spontaneity, all so important, are inevitably diminished by anything savouring of tactics or technique. With cancer there are additional difficulties due to deep-seated fears of a special kind not encountered in any other disease (or, more correctly, group of diseases), even when closely matched in terms of symptoms and prognosis. Many of those who have given their views have been psychiatrists or social workers-external assessors, so to speak, with all the advantages and disadvantages that this implies. Others have written only of the dying patient. Those of us directly concerned with the treatment and long-term follow-up of many patients with cancer of different kinds (some curable, some in relapse, some in remission) have had much less to say. One thing is certain. Whoever writes on this subject is walking into a minefield of misunderstandings. Some will always be determined to label him (on the basis of selective quotation) as one who "believes that patients should be told the truth" or as