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MEDICAL EXAMINER recipe feature PAGE 7
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AIKEN-AUGUSTA’S MOST SALUBRIOUS NEWSPAPER • FOUNDED IN 2006
OCTOBER 16, 2015
BREAKING NEWS T his happened to a Medical Examiner reader. At a scheduled appointment with her ob/gyn, one glaring anomaly stood out after the various routine tests: her blood glucose reading was nearly 400, about four times higher than normal. She was referred to another doctor that same day, who read over the first doctor’s findings and then, by way of announcing the diagnosis, said “Welcome to the world of diabetes.” The doctor then placed a small box containing a blood glucose monitor on the counter as she (the doctor) prepared to leave the exam room. “What do I do now?” asked the bewildered patient, who had known she was a diabetic for less than fifteen seconds. “Call diabetic services,” said the doctor as she walked out. While that might be called a textbook study in how not to break the news of a permanent and life-altering diagnosis, it is hopefully something of a rarity. Then again, medicine today sometimes bears an uncomfortable resemblance to an assembly line. We know of a doctor who last month saw 93 patients in one day. Doctor’s schedules are often plotted out eight hours at a time in 10- or 15-minute increments, and there is little room for unplanned expenditures of time. Any deviation from the schedule can have a ripple effect that significantly impacts patients and staff all day. On the other hand, a professional whose bread and butter is helping people would not be expected to say, “I’m on a pretty tight schedule here, so let me just spit it out: you’ve got cancer, and probably won’t be around much longer. There’s nothing we can do. Goodbye.” What is a doctor to say? Many of them, unfortunately, have plenty of practice. For that matter, what about us patients? When someone discovers they have a serious medical situation on their hands, there are people who need to know (see box at right): wives, husbands, children, parents, brothers and sisters, employers, and others. (Continued, far right)
MY FATHER BROKE THE NEWS My mother had cancer my entire life. She was diagnosed with Hodgkins Lymphoma while pregnant with me. The obstetrician noticed a tumor while doing an ultrasound. As I grew older I realized how serious her cancer was. I watched her undergo numerous rounds of chemotherapy and radiation. She would lose her hair and be bedridden for months on end. When I was 7, she was transferred to Emory University in Atlanta for 3 months to undergo a bone marrow transplant. I remember she was very weak and had even more scars on her body when she came home. We thought she was cured, but a few years later the cancer returned. She went through more chemotherapy and more radiation yet never seemed to get better. We celebrated my 12th birthday at University Hospital. I will never forget the day I came home from school and my father called my brother and me into the living room. “Boys...I have something I have to tell you. Your mother is not going to make it through this time,” he said as he started to cry. I had never seen my father cry before. He grabbed my brother and me and hugged us tightly. I will never forget that moment as long as I live. + — Ryan, Augusta, Georgia
It’s not just what; it’s who, when, where and how Being the bearer of bad news is a difficult and unpleasant chore, indeed (see “From the Bookshelf,” page 11). Just ask any police officer who has had to inform family members of the tragic results of a highway accident. They don’t do it by mail or e-mail, by text or by telephone; they do it the old-fashioned way: in person, face to face. Therein lies a lesson for the medical profession, which sometimes breaks serious news to patients by sending them test results through the mail, or perhaps even worse, when a member of the doctor’s staff who knows nothing of the diagnosis calls to schedule an accelerated follow-up appointment. A patient’s imagination can run wild in such situations. No one expects doctors to resurrect house calls for delivering bad news, but face-to-face is good, and it’s recommended by medical journals (like Community Oncology) and professional organizations (like the American Academy of Family Physicians), along with a few other excellent pointers we can all use when there is difficult news to share. The picture at left is a good summary of the who, what, when, where and how, and it suggests the noted S-P-I-K-E-S strategy for delivering bad news. You’ll note, for starters, the private setting.
Please see BREAKING NEWS page 2
HIGHLIGHTS: The #1 poster of all time • Page 4 The breast cancer no one talks about • Page 11