To Tell the Truth:
Delivering Bad News to Patients

“I tell you, Doc, I can’t wait to step onto that ship. I’ve been working so darned hard my whole life and, boy, do I ever feel like I deserve this cruise. We’re going all out, right honey? Marsha, here, she’s my angel, and we finally get to spend an entire month together, stress-free. Can you believe it, sweetheart? We’ve been planning this trip for almost a year!”

Dr. Miller responded, “John, it certainly sounds like you deserve this trip!” He remembered that John had retired from his job as a factory manager a couple of months before this visit. “How is retirement treating you?”

“Retirement has been great. I’m loving the extra time that I get to spend with my new grandkids—you know my daughter Shelly had twins. No more managing people, dealing with angry customers, worrying about inventory, getting stressed about costs. One thing, Doc, if you could just straighten out this pain in my stomach, I’d be forever grateful. Seems like it’s been around forever. I figured that when I retired, it would get better—stress related, I thought. I really want to feel good on this little trip to heaven we’re taking.”

“OK, John, we’ll take a look.”

After taking a thorough history, Dr. Miller examined John. His examination was normal, except for a slight bit of tenderness to palpation in the left lower quadrant of his abdomen. There was no sign of acute infection or surgical problem. In addition, John’s rectal examination was normal, but there was occult blood in the stool specimen obtained during the examination.

“John,” Dr. Miller said, “We will need to do some further testing to evaluate this blood in your stool. When do you leave for your cruise?”

“Doc, I’m heading out in 10 days. Can we do the test before then? I don’t want anything to be hanging over my head during the cruise!”

Dr. Miller referred John to Dr. Quaid, a gastroenterologist, for a colonoscopy the following week. Dr. Quaid and Dr. Miller were good friends, having attended medical school together, and Dr. Miller knew Dr. Quaid would treat John with respect. After the procedure, Dr. Miller got a page from Dr. Quaid.

“Bill, it’s Jim Quaid. I just finished up with your patient, John Davidson. He’s still pretty groggy, and I haven’t told him anything yet, but he had a pretty good-sized colon polyp that I took off. I don’t have the pathology report yet, but I’m guessing it’s cancer. How do you want me to handle this?”

Image Credit: Copyright © Norma Cornes.

Date Posted: 02/02/06 nas.

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