Bad News Bear.

There’s an aspect of being a doctor that never gets easy and that is delivering bad news.

In medical school we take a course called “Breaking Bad News“, but nothing prepares you for actually having to do it.

I’ve had my family practice for 7 years and have been practicing medicine for almost 10. I can still remember every single time I’ve had to give bad news.

  • While working at a walk-in clinic, over the Christmas holidays, I had to tell a woman she had pancreatic cancer.
  • In my first year of family practice, I told a woman she had cervical cancer.
  • In my second year of family practice, I felt a pancreatic mass in a 55-year-old woman; she lived for 4 years after that. I attended her funeral.
  • Three years ago, I felt a very abnormal prostate gland and new instantly the patient had prostate cancer.
  • A young woman, believed to be about 3 months pregnant came in for an unrelated matter and asked if we could listen to the heartbeat. She’d seen her midwife the previous week and they couldn’t find it.  Neither could I.  An ultrasound a few hours later confirmed what I already knew.  She’d suffered a miscarriage but didn’t know it.
  • There was an older woman who came to see me for chest pain. She had been coughing from a cold and had a lot of chest wall pain. An x-ray showed multiple rib fractures. Spontaneous rib fractures.  A week later, after sending her for a series of blood tests, I diagnosed Mulitple Myeloma.
  • Sometimes a diagnosis of chlamydia can be devastating.  It certainly was in the 31-year-old married woman who came in for a routine Pap.  Sadly, my bad news was instrumental in her later ending her marriage.
  • My first week back to work, I told a man he most likely had kidney cancer.  Welcome back!

Every time I have to deliver bad news I am reminded how fortunate I am and how fortunate my patients are for living in a country where, when its required, they have access to timely health care.  None of the above patients waited for more than a week or two to see a specialist.  Sadly, not everyone survives after being given bad news. I haven’t had to do it very often, but when I do, it affects me personally.  Often I can’t sleep for a few days.  Sometimes I worry (often unnecessarily) that I missed the boat and should have caught the illness at an earlier stage.  Anything else going on in my life suddenly seems not to matter for a while.

Bad news bear.

Sometimes that’s me.

 

 

9 thoughts on “Bad News Bear.

  1. 😦 Even so early in my career I have been around for the Bad News Bear… I think I’ve blogged about two of them – I know you’ve read one, but let me find the other… This is certainly not the “thing” I am looking forward to in the future.

  2. This is hard. I appreciate your post especially now because at my Family Medicine OSCE at the end of this week one of the stations will most probably be breaking bad news, and I don’t at all feel prepared for it – least of all to do it in real life soon.
    I think it’s impressive that you remember every instance of breaking bad news you’ve had though. It speaks of humanity.
    As for how lucky your patients are for living in a country with accessible healthcare: that much is true. On my rural family medicine rotation, we would query hepatocellular ca or oesophageal ca and many more, and only get specialist appointments for the patients a month or two later. Once a woman died literally the night before her long-awaited GE-consult.

    • Thank you for your comments. I appreciate it. I can’t imagine how difficult it must be to live where you do and be faced with wait times and be forced to watch your patients succumb to their illnesses because of it. Must be heartbreaking. Thank you south for sharing.

  3. It’s always hard to break bad news. I wish that everyone in the states had the same access to care as your patients! As a community physician in a federally qualified health center caring for patients without health insurance, I’ve taken care of at least two patients who received their diagnoses after an emergency hospitalization, then the cancer docs who saw them in the hospital refused to follow up, instead sending them to my clinic for care. So first they needed to wait for an appointment with me–three weeks for one woman, which is actually pretty quick–then all I could do to expedite her care was to advise her to pick up her records from the other hospital and go to Cook County hospital’s emergency room, where she would be connected to oncologists regardless of her insurance status. She died within three months. Your comment on how fortunate your patients are to live in a country with timely care reminds me very strongly how we live in two different worlds, two different medical systems, for those with and without health insurance. Your patients are very lucky. I wish mine were too!

  4. When you are on the receiving end of bad news, you realize how important it is to have a doctor, or a best friend, that you trust and who is sincere. You have been there for my hardest moments and wouldn’t change that for anything. Love you.

  5. A really genuine and touching blog. Your patients are lucky to have you, someone who feels their distress, disappointment and pain. My husband is a thoracic surgeon who specialises in lung cancer surgery. I see the way it affects him and how well he handles it, it makes me cry for him inside. He calls it ‘the Porsche’ moment. When you realise that life can be snatched away from you in an instance, so you might as well go out and splurge on a Porsche! He still drives a Toyota Corolla – so we count our bessings – but it is a good thing that you feel so terrible about it. It means you care. *hugs*

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