Sunday, March 15, 2009

Teleprompter case

One of the hardest parts of the job is having to give bad news. This is especially true after exploratory surgery when you find out that the tumor is far worse than imagined and that it has spread extensively. (I think that the pathologists should have to talk with the families and patients, after all they are the one who really decided that the cancer was there). As soon as you walk in to talk with the family they sense what is going on. They know if it is good or bad. Sometimes it is hard to find the right words that convey the information and at the same time comfort. I would love to have on of those presidential teleprompters to take with me where others can sit back and give me the words to say and answers to the questions that I am asked. Change that, I would rather have those people that are sending the stuff to the teleprompter just talk to the family.


SeaSpray said...

No Throckmorton... a teleprompter would be a horrible idea and so would getting the news from the pathologist. I know you were being facetious about the teleprompter.

Giving that kind of bad news must really suck.

But speaking as a patient... I would feel bad for my doctor knowing they would be disappointed/worried and then having to deliver the bad news... I would really feel for them.

Of course I'd be equally upset by the bad news for me or anyone I was close to.

But Throckmorton...and I am sure you know this... there is no one person on the planet better to deliver the negative report than the treating physician...assuming the physician isn't a cold hearted ass.

At least if there is any kind of patient-doctor bond... I think while the news is distressing...coming from a trusted, compassionate doctor would soften the blow. Then again..maybe if the news is dire..they don't hear/process much. I don't know.

And I think making it clear to the patient that you will be there for them through thick and thin...if that is possible..that together you will fight what ever challenges come up...well..I think it provides a much needed anchor in the patient's world where they mus feel like they are suddenly free falling out of control.

Depending on the pt-doctor relationship or perhaps the moment at hand... certainly sincere eye contact, holding a hand or a warm hug... at whatever point that seems appropriate..if at all would be important. I imagine things like that vary from patient to patient.

I also think that even though it sucks and you dread telling the patient... maybe look at it as an opportunity. By that I mean... this serious, potentially life altering responsibility ... this sacred moment in time...has fallen on your shoulders.You are the bearer of the horrendous news.

The opportunity is that YOU will talk to them with compassion, support,honesty, but with encouragement... if at all possible.

I think providing them with every available resource for information, options for specialists and somehow through it all let them know you are there for them.

I know your point is you'd rather not do this at all. But the fact that you write about it tells me how compassionate you are and it sounds like your patients are blessed to have you.

Of course I don't have a clue what it is like to walk in a physician's shoes and so I am speaking from the patient perspective.

Andrew_M_Garland said...

I can imagine the time when government management of healthcare has changed things a bit.

The legal requirements for breaking the bad news (1), the warning that it may be unsafe to drive, walk, eat, or make important decisions during this time of crisis (2), and the requirements for informing the patient about where to apply for specialist treatment (3), will require that the teleprompter be used, along with an electronic download to the patient's designated Electronic Medical Notice Address Link (4). The patient and family will have to sign off in detail (5).

The physician will be discouraged from saying anything. Additional information will be deemed unnecessary and wasteful of time.

(1) Uniform Information to Patients Protection Act.
(2) Disclaimer and Warning of Increased Personal Risk From Emotional Trauma Provision.
(3) Uniform Access To Specialists And Continuing Care Ruling.
(4) Electronic Medical Notice to Patients Act.
(5) Acknowlegment of medical information transmission form MIT33C.

SeaSpray said...
This comment has been removed by the author.
Throckmorton said...

Mr. Garland

I love it but I hope that it doesn't give them any ideas!

Andrew_M_Garland said...

I don't think we have to worry. They have thousands of plans, but very few ideas.