Saturday, October 22, 2011

how not to give bad news

part of my job is giving bad news.  it goes with the territory of doctoring.  and of all the bad news i give (i consider diabetes bad news) nothing is tougher than telling someone they have cancer. i really can't think of any other single word that can turn someone's life upside down so entirely and so succinctly.  i don't even like saying the word.  the "cer" part makes me think of slicing knives.  sometimes i catch myself going to great lengths just to avoid saying it, using stand-ins like growth, mass, tumor.  these are marginally better.  and i know once i say that c word, my patients will hear little else. but i try very hard to do this part of my job right, face to face, with plenty of time, because i feel that if it isn't done right, then the trauma of the diagnosis is heightened.   before we end our conversation, i try to give my patient the sense that we have a plan, or if not an entire plan, then at least a next step.

but as difficult a conversation as it may be, if someone has to tell one of my patients they have cancer, i want it to be me.  not the surgeon, for instance, that left the message, 'it's cancer, call me back.' on my patient's answering machine this week.  and anyway, how could i possibly complain about having to give someone bad news?  after all, it is not me that is being diagnosed with cancer.


  1. ugh. I got the news about my husband over the phone. My husband had gone into the ER on instruction from his GI doc after pain following a gastroscopy, and the CT showed.... well, let's just say he clearly only had a few months left (he was 38). My dh was out of it from the whole ordeal, so the GI called me and couldn't QUITE manage to tell me/us. He did say it was "most likely malignant" and fortunately I knew what that meant. It was a few days later that we got the whole story from an actual oncologist.

    It's a good thing I had some idea of what the GI was describing from the CT scan or I would have really been thrown for a loop. He probably should have just manned up and told me, but it's not that big a deal in the end. It's not like it affects the outcome!

  2. Solitary diner and I have been having a comment conversation about the same subject. My live imploded the moment the doctor told me (in a consultation room, I already knew it was bad)that I had six large tumors in my breast and a grossly affected lymph node. He was 90% certain that it was malignant and had metastasized. That was the point where BC and AD came to mean Before Cancer and After Diagnosis to me. No one should ever hear that news on a voice mail. It should always be in a consultation room with a doctor who will look the person in the eye and kindly tell the truth in words that are easily understood. It isn't a good situation for either doctor or patient, but it must be done. If the patient reacts badly, you shouldn't take it personally. It is a result of instant shock.

  3. A doctor, like anyone else who has to deal with human beings, each of them unique, cannot be a scientist; he is either, like the surgeon, a craftsman, or, like the physician and the psychologist, an artist. This means that in order to be a good doctor a man must also have a good character, that is to say, whatever weaknesses and foibles he may have, he must love his fellow human beings in the concrete and desire their good before his own