Anthony L. Back, MDDr. Back is a medical oncologist who specializes in treating cancers of the gastrointestinal system. He is an expert in communication between physicians and patients and acts as a mentor for many new physicians.
Patient Care Philosophy:The best medical care is a combination of technical expertise and listening to the whole person. My aim is to combine both, and lead a medical team that strives for excellence in both areas.
Dr. Back's Resume
- Affiliate Member, Clinical Research Division, Fred Hutchinson Cancer Research Center
- Professor, Oncology Division and Adjunct Associate Professor, Medical History and Ethics, University of Washington School of Medicine
Gastrointestinal cancers, ethical issues, communication, palliative care
Education And Training
- MD: Harvard Medical School, Boston, 1984
- Residency: University of Washington, Seattle, WA, 1984-1987
- Fellowship: University of Washington, Division of Oncology, Seattle, WA, 1988-1989
- Fellowship: Fred Hutchinson Cancer Research Center, Division of Oncology, Seattle, WA, 1989-1991
Dr. Back's Story
Having Difficult Conversations about Cancer
SCCA’s Dr. Anthony Back has a tough job: He teaches other doctors how to have “difficult conversations” with their patients—how to tell a woman that she has cancer; how to tell a man that his cancer is not responding to treatment and that he will soon die.
For doctors, he says, giving bad news is “one of the most stressful things they do.” And, depending on when and where they were trained, they may never have been taught how to talk with their patients.
Dr. Back says good communication with doctors is important to people with cancer “because they need to get more than ‘technical’ medical assistance when they go to the doctor. They should expect more. Patients should feel confident going into an appointment that their concerns will be discussed.” He believes cancer patients need doctors who understand what they are experiencing and who are not afraid to talk about it.
Doctors benefit as well
Doctors who know how to have these difficult conversations with their patients are less likely to burn out, says Dr. Back. They are better able to help their patients make the right decisions about cancer treatment. “Medicine is actually a relationship business.”
Doctors who are good communicators listen to their patients, Dr. Back says. They show empathy. They don’t rush through difficult conversations. And they acknowledge their patients’ emotions.
Dr. Back trains doctors in a number of settings. He made a presentation at Grand Rounds at University of Washington Medical Center titled “Difficult Conversations: Talking About Life-Threatening Illness.” He organizes retreats for oncology fellows that are sponsored by a grant from the National Cancer Institute (NCI), and is working on improving communication at SCCA.
He also mentors young doctors-in-training, including residents and fellows at SCCA and its founding organizations, UW Medicine and Fred Hutchinson Cancer Research Center.
In addition to training doctors, Dr. Back does research on communication between doctors and patients and has published a number of papers on this topic. He recently launched the first smartphone app to help med students and doctors learn to become better communicators, and has written a book for doctors.
Talking to his own patients
Dr. Back also treats patients at SCCA. His patients include people with colorectal, liver, pancreatic, and stomach cancer.
He suggests that his patients bring a written list of their questions to each appointment. He uses the lists to help prioritize his time with patients and make sure that all of the patients’ questions are answered.
He doesn’t tell his patients what to do. “Communication between Tony and his patients is always a two-way street,” says a fellow physician. “He never dictates to or talks ‘at’ people.” Rather, he and his patients make treatment decisions together, focusing on finding the right answer for each patient.
“He encourages active involvement in the decision-making process,” says Dr. Back’s oncology nurse. “He communicates in a manner that shows his genuine concern and compassion for his patients and their families.”
An SCCA staff chaplain stated, “I've been with Tony as he's given difficult news and here is what impressed me: If it's clear that a patient does not understand or is not realizing what he is saying, he will say it a thousand different ways to make sure that he or she is hearing it.
“He is always very gentle, and he listens way more than he talks. Paradoxically, he is also not afraid to laugh in a situation like this. I've heard patients make jokes about their prognosis, and he'll respond to the joke and then very gently steer the conversation back to what he was saying.” Dr. Back has “a deep appreciation for spirituality, knowing that medicine is not simply about drugs and surgery and cures.”
Bringing culture change
Dr. Back was born and raised in Vancouver, Washington. He is a graduate of Stanford University and Harvard Medical School. He did his residency at the University of Washington Medical Center, followed by an Oncology fellowship at Hutchinson Center.
He joined SCCA in September 2004 as a medical oncologist and director of the Program on Cancer Communication. He is also an associate professor at the University of Washington.
Dr. Back says the death of his mother from aplastic anemia when he was a college sophomore was a “wake-up call” that helped make him the doctor he is.
“I feel that my calling is to be a healer in this world,” he says. “And in my research, there is a little piece of culture change that I’d like to make happen in oncology: Really good communication—the kind that would make patients feel heard and respected and informed—because it is one of the ways that physicians can be healers.”