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Old 10-10-2011, 01:45 PM   #41
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I had some tests done this morning and am waiting for results.

If it should be something serious such as cancer, I am hoping my Dr delivers the news over the phone in a factual method so I can process the info rather than having to receive the initial news face to face which will result in me blubbering any not gaining anything useful from the visit.
This is to me an inherent difference between folks our age and those older than us. I'd far rather get bad news by phone or in an email than face-to-face. I could then have the opportunity to marshal my defenses and come up with the questions I need to have answered. The whole "call you in to tell you the bad news" seems archaic to me and I have no idea if it is even done anymore, unless you are already in the hospital and the doc comes by to tell you.

Spirit, your story is a moving one; bless you and your family on this Thanksgiving Day.
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Old 10-10-2011, 02:27 PM   #42
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About 30 years ago we had a infant son premature never left the hospital and after 4 months it was clear to the doctor that he was not going to make it. The doctor told us that he had a 0% chance of survival, and then went on to answer our questions in a very compassionate manner. He had been giving us updates almost every week for several months, however, that was the final one. My son passed 2 weeks later.
I get to do that a lot. Or at least I used to, in my previous j*b. I find I really have to tailor the discussion based on my relationship with the family, what they have been told already, and what they remember and acknowledge about what they have been told. It's often a process that takes some time, and sometimes other family members can be very helpful. Or not.
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Old 10-10-2011, 03:08 PM   #43
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How would you deliver the bad news to your best friend, Michelle?

What would you need from your doctor when she/he tells you the bad news?

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I had some tests done this morning and am waiting for results.
I hope everything is ok DM....
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Old 10-10-2011, 05:32 PM   #44
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Thank you for sharing, spirit. Like you I am grateful to be part of this ER community. I joined this website a year ago, and I have enjoyed reading and learning so much from all the contributors. Thank you, everyone.
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Today is Canadian Thanksgiving and I am grateful for all the wise and caring people who selflessly give of themselves here on this forum.
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Old 10-10-2011, 07:29 PM   #45
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When Lena was having tests regarding headaches, we weren't getting the full story, but the docs could be forgiven because they didn't know yet.

To save some time they sent me to pick up the MRIs. As soon as I got them I pulled them out and looked at them in the car. The golf-ball sized tumor was plain as day.

Things turned out OK.
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Old 10-11-2011, 10:59 AM   #46
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When DW was finally diagnosed with lung cancer, the progression of tests pretty much hinted at what the diagnosis would be. After fine needle biopsy it was confirmed as cancer, and the doc was straightforward. This is Cancer, not-small cell, it looks like stage one or two, possibly three but not likely, can't know until after surgery. If it was small cell it would have been a totally different decision process. We were prepared for either result. Docs know what that means, others can do their homework.

Options were described as removing the cancer, removing the lobe of the lung with the cancer still encapsulated, or do nothing.

DW had no intention of being subjected to radiation before or after. The Surgeon was informed of this decision BEFORE the fine needle biopsy. She and I have seen too many cooked people in extended misery.

She opted for lobectomy, and, as was predicted by the surgeon it was the best option and post surgery the lab was able to determine the correct stage: 1A.

We appreceiated the surgeon's brief and to the point explanation, and thereafter, he was open to and fully responded to any and all questions by DW and I.

Post surgery briefing by him was again brief and to the point. He did fully respond to all of my arcane and probing questions without fudging. In fact he said, I had some of the most relevant and probing questions he heard pre and post surgery from lay folks.

Moral of the story, do your homework, do research, try and understand the problem, the consequences of various treatment methods and their effects on the one with illness and how they effect the caretaker. And ask for plain English explanation if doc or nurse use trade language.

Always keep in mind the question: whose life is it, anyway? It is up to you to answer that question. Be prepared to live with consequences of the nature your answer, for a long time. Because you will. And can't escape it or pass the buck.

Again as in all things in life, do your homework. Or in techie language: RTFM


RTFM= read the f*cking manual.
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Old 10-11-2011, 11:33 AM   #47
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I personally would want the doctor to go straight to the point using plain English. A bit of empathy would not hurt either.

Here are a few examples of bad delivery IMO:

My wife's doctor is terrible at delivering news in general. A few months ago, DW was feeling really tired and had tests done. Her doctor called on Friday night and said "I have just received your test results back and we need to talk, come by my office on Monday". My wife prodded her for more details, but she refused to say anything on the phone. So we spent the week-end freaking out and envisioning worse case scenarios. And then on Monday, we found out that it really wasn't as dire as we had expected.

A few years ago I had my cholesterol checked. The nurse came back with the results and told me that it was "really, really bad". Her alarmist tone started to concern me but then the doctor walked in, looked at the results and said "meh, you're borderline. With your family history, it's nothing".

Later on, the doctor decided I should get an EKG. While reviewing the results with the nurse, they kept saying things like "do you see that?" "yeah, it's weird". They were talking like I wasn't sitting 4 feet away and staring at them. After a while, I asked if there was something I should know about. "Oh no, you're fine" said the doctor.
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Old 10-11-2011, 02:42 PM   #48
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Thank you to each and everyone that has responded. The information is very valuable to me, and has given me many ideas on how I can improve on this difficult conversation.

Some of you have highlighted some of the obviously poor techniques that some MD's use to deliver bad news. Unfortunately that happens far too often and underscores the importance of trying to do it properly. Half of my mentors used the "pass the buck" technique...ie "We couldn't quite get all the cancer, but now we'll send you over to the oncologist to see what they can do" and the Oncologist is stuck delivering bad news to a patient hopeful for a cure. I vowed during residency that I would never do that. And I always turn my pager/cellphone off. I can only imagine how difficult it is to receive such news from a visibly distracted doctor.
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Old 10-12-2011, 08:40 PM   #49
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There are a number of books on this subject. My personal favorite is How to Break Bad News by Robert Buckman He gives one of the most entertaining lectures on this topic or any topic
I have bad news. Dr. Buckman died this past weekend on a transatlantic flight.

Renowned oncologist Dr. Robert Buckman dies on flight to Toronto - Winnipeg Free Press
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Old 10-12-2011, 08:50 PM   #50
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I have bad news. Dr. Buckman died this past weekend on a transatlantic flight.
Did you need to be quite so abrupt?
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Old 10-12-2011, 08:53 PM   #51
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I have bad news. Dr. Buckman died this past weekend on a transatlantic flight.

Renowned oncologist Dr. Robert Buckman dies on flight to Toronto - Winnipeg Free Press
Wow, talk about bringing this full circle--here's how Buckman's wife broke the news to his colleagues, from the article:

Quote:
Dr. Mary Gospodarowicz, medical director of the Princess Margaret cancer program at the University Health Network, said she received the news from Buckman's wife, Dr. Patricia Shaw, a pathologist at the hospital.
"She basically emailed us saying that he was on the flight back from London, and he died on the plane," Gospodarowicz said.
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Old 10-12-2011, 08:59 PM   #52
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Did you need to be quite so abrupt?
Based on the feedback in this thread, yes. What I read suggested people like to get right to the point. And after all, this is just "news", not something about your own health.
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Old 10-12-2011, 09:16 PM   #53
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Based on the feedback in this thread, yes.
Okay. I was just kidding. I ran across this video by Dr. Buckman in which John Cleese makes a brief appearance playing a hapless cancer patient being snowed by an incompetent radiation oncologist:
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Old 10-25-2011, 09:41 AM   #54
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I really don't know which is the best approach. A too soft approach, and that can lead to false hope, a too direct approach and that can seem callous and uncaring. This brings back memories when my brother was diagnosed with inoperable liver cancer. Once all the information was filtered down, it was difficult to understand just how serious the situation was. This may have been from denial by the patient/family or the doctors hesitant to fully break the bad news. It was like, the prognosis depended on which doctor you talked to. One would say, "It doesn't look good, but there are experimental treatments out there." Another would say, "It's bad..reallly bad." In my brother's situation, what it took to punch us right in the face was the doctor said to my brother's wife "Your husband is a sick man. He'll be lucky if he lives another month. He belongs more in a hospice than a hospital" That the doctors words may have seemed cold, I did find it helpful to give it straight.

Going off on a tangent here...but I remember on the day of his death, he was transfered to a section of the hospital for the gravely ill (forget the name of it). Seeing him that morning, I knew he was going to not make it through the night. Him barely conscious, I nurse came and and still had to take a blood sample. I was thinking.."how stupid" it really didn't serve a purpose to struggle to draw blood one more time..what? Just to follow hospital rules?
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Old 10-25-2011, 11:08 AM   #55
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I have a friend who is a retired general surgeon who practiced in cancer centers. His SIL was recently diagnosed with cancer, as he put it 'this is very serious.' It must be very difficult for him knowing fully what SIL is facing.
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Old 10-25-2011, 11:21 AM   #56
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I've always felt that when it's my turn to receive the bad news, I'll be like Gary Cooper playing Lou Gehrig in "The Pride of the Yankees" when he asks "I want it straight, tell me doc, is it three strikes?" and the doc replies, "Yes, three strikes."

But I don't know if I'll have the grace to handle the news that way.
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Old 10-25-2011, 11:44 AM   #57
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Wow, he was only 63. That said, I would think that just dying in your sleep is a brilliant way to go, though not sure that doing it on a plane is the best locale.
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Old 10-25-2011, 06:51 PM   #58
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Hey, he was the same age as I am.

I will go skating tomorrow. Not that it has anything to with Dr. Buckman.


By the way, a doctor looking at his photo in the article, as if he was a patient sitting on the exam table, would evaluate his health based on instant impression, as?

I know it is a loaded question. Any takers? How about the amateurs?

Edit add: Did he wear earrings at one time or is that a huge dent in his left earlobe.

We all form opinions of people's health at first glance.
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Old 11-01-2011, 04:59 PM   #59
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Unfortunately, I'm in the situation right now about expecting to receive very bad news soon. My friend is in very bad health. From ER to nursing home back to ER and now in a LTAC (long term accute care) hospital. She has many problems going on, but the biggest one right now is her lung function -- needs assistance from a venilator. Myself, her family has fingers crossed that she can be weened off the venilator (the ER where she was last tried, but wasn't successful).

It's so heartbreaking. When she is awake (they are giving her sedated to keep her calm) her mind is alert. Yet she's trapped in a body that isn't working right and unable to speak with the air tube on.
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Old 11-01-2011, 05:11 PM   #60
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Unfortunately, I'm in the situation right now about expecting to receive very bad news soon. My friend is in very bad health. From ER to nursing home back to ER and now in a LTAC (long term accute care) hospital. She has many problems going on, but the biggest one right now is her lung function -- needs assistance from a venilator. Myself, her family has fingers crossed that she can be weened off the venilator (the ER where she was last tried, but wasn't successful).

It's so heartbreaking. When she is awake (they are giving her sedated to keep her calm) her mind is alert. Yet she's trapped in a body that isn't working right and unable to speak with the air tube on.
That is too bad. We just went through a similar situation with a close relative and it is painful to watch the suffering, especially when there are frequent setbacks and trips to the ER. Hopefully your friend's situation will resolve itself and she won't have to suffer unnecessarily.
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