Not every patient encounter is a happy one.
Sometimes we have to be strict, or firm. Sometimes we walk into the room and find out the patient is unhappy with us. The worst is, when we have to walk into a room and tell someone news they don’t want to hear.
In my electronic medical record, I have little ovals at the top of the screen. They each designate something different. One is for patient visits, another for patient phone calls, another for refill requests, and then there is the one for labs and imaging. That one always keeps us the busiest. I make a point to get it down to zero every week. I have time set apart in my schedule, where I don’t have patients scheduled in order to get it done. Most doctors do this. We call it our “admin time”. This week I was scrolling through and saw the results on a patient that I had been waiting for, and I quickly opened the file to read the results, and as you can imagine, by the title of this post. It was not the best of news.
My heart simultaneously sank, and felt heavy. If you had a heart monitor on me, it would have probably skipped a beat, and raced, and I know my respiratory rate increased. In that short moment of seeing the results a million thoughts went through my mind. Is this a good day to tell them? Should I wait until after the weekend? Do they have a support system? How easy is transportation for them to all the future specialist visits they are going to have to endure? How is their overall mental health, and how is this diagnosis going to affect them?
I read the results through again… did I miss read it? Did I miss something in the report? No, it was as I first interpreted it. I had the patient called to come in the next day.
I am fortunate that in my job, it is not common for me to have to share these types of results very often. Although, even if I had to do it every single day, I doubt it would be easier. It weighed heavy on me when I went to bed, and it was the first thing I thought of when I looked at my schedule in the morning. And for all the angst I have, I can only imagine what the person waiting for the results felt like. The worry and fear and uncertainty. They were probably praying that it was really just fine, and that hopefully the doctor just was trying to explain some unusual, but not serious results, that would have been too complicated to discuss over the phone. They could then go about their day and weekend, and life.
There really is no good way to give people news they don’t want to hear.
I was always taught to just come right now and say it. Bluntly, but not abruptly. Don’t mince words. State it clearly. Make sure they understand exactly what the diagnosis is. Give them time to process it.
They are always stunned at first. For some it lasts a few seconds, for some a minute or two. Once the shock wears off, some start crying. It is my job at that point to be silent, and give them all the time they need. When they are ready, we discuss the next step.
Never do I enter the room with out a plan. It may not be a fully fleshed out plan, but I always have the next step. That may be a referral, or another test, or a medication. There is always clear follow up. Patients are many times afraid to ask about prognosis, but I am always prepared to tell them if they ask. The visit can take fifteen minutes, or it can take an hour, it is individualized, and in that moment, they are my only patient. When we finally finish up, and they head out to the front desk to arrange that next step, I usually head back to my office. During that time in the room with the patient, I am living their life, and absorbing their fears and worries and pain, and I usually need about 10 minutes to re-center myself after that visit, so that I may be able to focus on the needs and wants and worries of the next person who is waiting in a room for me. I am sorry if I run late.
And to all of you over the years, for whom I have had to give the worst of news, I am sorry. I haven’t forgotten any of you, and I am so impressed by your courage and strength and fighting spirit.