Tuesday, January 12, 2010

Bad news

It's not often I'm the one delivering the news that a patient of mine has cancer. It may be the surgeon, the specialist, the mammogram, or the ER doc that gives the bad news. I don't avoid it; it just works out that way.

I had to today. Just the fact that he had an appointment for an acute concern was a red flag with this guy, who is nice enough, but doesn't relish coming to the doctor. My visual impression of him reinforced my concern, his complaints even more so, and his physical exam sealed the deal.

My heart sank.

I always appreciated bluntness when we got news about Henry. No mincing of words, no dancing around.

I hope he did too.


rlbates said...

It never gets any easier, does it?

socks said...

I'm sure you delivered the bad news in the best possible way.

Sorry for you and even more so for him.

A Doc 2 Be said...

I can only imagine how it impacted you inside as well, Dr. Smak.

winecat said...

I'm sending a few hugs your way. I'll bet you need them today.

Sybil said...

I am sure he does. Maybe not immediatley but certainly as the days go by..
Bless You
Love sybil x

...tom... said...


My visual impression of him reinforced my concern, his complaints even more so, and his physical exam sealed the deal.


I had always imagined that a diagnosis of cancer was a long, drawn out deal . . .involving smears and biopsies and 'consults' and sophisticated 'miracle technology' peering deep inside the body's cells to be sure.

You are saying you diagnosed a cancer, of whatever etiology and 'pathogenicity' (wrong word, but I am sure you know what I mean..), you diagnosed that spectre within the time frame and complexity of an appointment, an exam, an office visit..?!?

Maybe I should be more concerned when I schedule an appointment with my own physician for whatever reason.


Dr. Smak said...


In general you are right. Which is why I'm not often the one giving the news, because it takes so many steps to get there.

But, there are times when things are REALLY clear, really quickly. There are times when saying things like "unusual finding" or "suspicious lump" is more than an understatement, it's disingenuous.

The follow-up tests have confirmed for this gentleman that things aren't so good. I'm not purporting to be a fabulous diagnostician. This one was just obvious.


...tom... said...


Thanks Dr. S...

Not doubting . . .just did not realize that a definitive diagnosis could ever be made that . . .not 'easily' because that negates the skills/experience required to put the puzzle together, but that ...quickly.

Thanks for the response.


ADB said...

Whereas the primary concern lies with the patient, it is good to see this from the physician's perspective. I hope your patient is able to be treated, and possibly make a full recovery

Jobbing Doctor said...

Dear Dr Smak,

You sometimes think that you are alone in your grief, and to some extent you are. It is true that others you love are also going through grief, but we all cope differently, and uniquely, although at the same time.

I was directed to your blog when I put up a post about a child dying, as it would have been our son's 23rd birthday.

You spot the 'would have' immediately, don't you? Laurence (our son and youngest of 4) died suddenly on 15th December 1990 aged 3y 11m in his sleep. There was never a satisfactory reason for his death - possibly sudden infant death in epilepsy (SUDEP).

I am a family doctor in England with three daughters who were older than Laurence. It took me 10 years to even look at a photo of him. I still get some grim moods that Mrs JD and I cope with.

I do hope you are able to cope, and would welcome communication if you think it might help. Maybe you could take a look at my blog on thejobbingdoctor.blogspot.com and see if it chimes with your views.

Thank you for your brave and beautiful blog.


StorytellERdoc said...

Good for you for being honestly blunt with the patient...that is necessary sometimes...

Anonymous said...

Dr. Smak, Am sorry that your patient received this diagnosis. Am sorry that you had to be the person to deliver the diagnosis. But in my heart, I know that you did it with compassion and grace, and empathy.
take care of your self

radioactive girl said...

I have had two times that I was diagnosed with cancer. Well, one time was definite, I am still not sure what the second one was because it is all so confusing.

When I got my first diagnosis the doctor answered all my questions, was honest about which parts would suck, and why, etc. I still love that doctor for being so honest with me and telling me without sugar coating it.

The second time the doctor kind of talked in circles or talked without answering my questions but in such a smooth way that I didn't realize he had really said nothing until I left the office. He used words like "funny looking cells" and "similar to dysplasia" and when I asked him to clarify, he talked and seemed like he was answering my questions but wasn't really saying anything meaningful at all. I still think he is a nice guy and a great doctor, but I would probably never go to him again because he was so confusing.

I am sure your patient appreciated you being honest. I know I would.