When a person is sick, they are stressed and anxious. No surprise. And it’s human nature to fill in the blanks with bad news. That’s why ambiguous information can be magnified into a worst case scenario.
A close relative was being evaluated to a medical condition. He had some lab work done and was told to follow up in two weeks. Then came a call from the nurse, asking if he could come in the next day. Instead of asking the nurse if all was OK, he just said OK he’ll come in.
I was called asking for my interpretation. My gut response was that there was an opening and they were hoping to fill their schedule. But, I could not rule out the possibility the lab returned a worrisome result.
So, 24 hours of worry.
The next day, the doctor could not have been more gracious and helpful. He explained that there was an abnormality which explained the symptoms. If it was what he believed, the diagnosis was treatable and could help the symptoms. It’s the type of diagnosis most physicians would have missed. So, kudos for digging deep and making a tough diagnosis that may very well fix the problem. And kudos for getting my relative into the office ASAP to address.
To be sure that the lab result was not a harbinger of something worse, my relative is being referred to another specialist to give additional guidance. But, there’s a plan in place.
On a separate front, many years ago, my wife had a biopsy on Friday. The initial result was likely available the same day. But, she did not get a call with the all-clear-sign until Monday. While 3 days is pretty quick turnaround time, when someone is waiting for what they perceive to be life or death news, a weekend is an eternity.
Are there ways to mitigate a patient’s anxiety when there’s an information vacuum? Of course. It’s communication. Most patients are actually better at receiving bad news than ambiguous news. So, a heads up as what a surprise office visit might be discussing is more likely than not to help manage a patient’s expectations. And a reassuring call on Friday afternoon is likely to make you look like a rock star. It certainly makes for a better weekend.
What do you think? Share your comments below.
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You’re damned if you do and damned if you don’t. I was urged, as a young doctor, never to give any bad news on a Friday afternoon, when nothing could be done about it. If the patient knows to expect a call on Monday, that gives you time, even if the result is known on Friday afternoon, to set up the necessary consults or at least figure out who is in town and who could potentially see the patient to take matters further. If you tell her the bad news on Friday evening, is her weekend going to be any happier?
And we all know that the preliminary results that a pathologist might call you about on Friday afternoon may sometimes need to be clarified by further stains or a second opinion. There’s a downside to both ways of handling the situation, though you concentrated on only one. More important is the kindliness and sensitivity and competence of the person whom she sees to discuss the results when they are available.
We as physicians don’t appreciate the anxiety of patient waiting in ambiguous circumstances. That is because we and our immediate families go to the head of the line typically.
Can one imagine what it is like in Canada or in Britain under single payer when a diagnosis is delayed for months or longer and treatment delayed for even longer still? How can folks be so stoic under the circumstances? That is their culture not the American culture. Our culture wants to fix things now if not sooner, and get things done, improved, and out of the way in an instant.
Our culture since the advent of the computer age, is that everything should be done in the length of a mouse click. The real world doesn’t operate that fast.
The key to all of this is communication, kindness, patience, and sensitivity to the patient and their needs. Some patients will be gracious others will not. But we cannot let their response dictate ours which should always be professional. Sometimes it is hard to give bad news to patients, but we should still do it with skill. There are too many instances where such bad news is given and then the physician just abruptly leaves. Bed side manner seems to be something that is no longer taught or valued by our medical system.
Even though it is still valued by patients.
As usual, a great topic on a Friday. I look forward to these little brain teasers before the weekends. Communication without arrogance is the key. I still run into physicians who think they are so much smarter and better than those we take care of. Be a friend, be a peer, be a neighbor and any news is easier to take.