Giving bad news: it’s part of my job

I don’t wait till the end of the day

When there’s nought but bad words to say

I think that it’s best

To give one more night’s rest

Then suggest that it’s time to pray.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. Assignments in Nome, Alaska, rural Iowa, and suburban Pennsylvania stretched into fall 2015. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor. After a moose hunt in Canada, and short jobs in western Iowa and Alaska, I am working in Clarinda, Iowa. Any identifiable patient information has been included with permission.

Part of my job is to think of the worst things I can think of, and a couple of times a day I will tell a patient that what they really want to do is to walk away from the hospital shaking their head and muttering that I’m nothing but a darned alarmist. I run a lot of tests.  Mostly I look for things I can do something about.  Sometimes I run studies so as to hand the specialist a patient with a clear-cut diagnosis, or, at the very least, the first level of testing completed.  But sometimes I’m looking for bad stuff, mostly to reassure patients.  I’d rather be happy than right.

Rarely, the battery of lab and x-ray comes back normal. Most of the abnormalities, however, come as no surprise.  People know the dangers of drugs, tobacco, alcohol and promiscuity.

Every once in a while, I have to give bad news. And, after all the labs and CAT scans and MRIs I’ve ordered in the last few days, I’m going to have to give some Very Bad News tomorrow.

The report came in at the end of the day. I don’t like to give bad news on a Friday or of an evening, when we have nothing to do but wait.  And I don’t let the nurse give the bad news, that’s my job.  I prefer to give the worst news face to face, but once in a while, for the expeditious good of the patient, I have to do so by phone.  .

People have suspicions when I start the testing, and for the most part when I sit down with them they already know the problem. So I ask, “What do you think the (blood test, CAT scan, biopsy, MRI) showed?”  Almost always they’ll say they don’t know, and I change the subject for about 5 minutes, and ask again.  The third or fourth time they come up with the diagnosis, and I confirm it, and I tell them as much as I can about what to expect.

I emphasize uncertainty when I find it, but I don’t hold out false hope. And if bad news involves a child, I come prepared for verbal abuse when the parents blame the messenger.

It’s part of my job.

 

 

 

Tags: bad news, Blood tests, CT, MRI