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.

 

 

Family Medicine Forum – Montreal, Day 1

Day 1 of the conference is in the bag.

I’m exhausted.  Mostly because I was out last night with my friends at DNA here in Montreal. We did the tasting menu, with alcohol.  A lot of alcohol.  I’m still a little bit hungover.  Did I mention there was a lot of alcohol?

I just finished a 4 hour session on Men’s Health.  It was great, but it was very biased toward prescribing testosterone.  So much so, that one of the doctors in the group suggested to the facilitator that he disclose his conflicts of interest at the beginning next time.  Ouch.  It’s not like he was promoting one brand of testosterone over another.  There’s one or two kinds of injectibles, one kind of oral and two kinds of topicals.  There ain’t a lot to choose from!  And the main topic was symptomatic hypogonadism.  How else is one to treat it? Seemed like a no-brainer to me.   I was always afraid of testosterone replacement therapy because of hearing all about how it caused prostate cancer, or rather, increased a man’s risk of prostate cancer, when in fact, that is just a myth.  I learned today that testosterone will increase a man’s small, shriveled up prostate to the size it would have been had he had normal testosterone in the first place.  If there was a teeny nidus of cancer in that shriveled up prostate, then testosterone treatment would, in fact, unmask it, hence bringing it to attention earlier.  Good, right?

Bottom line is that I am now a little bit more comfortable in how I’ll approach the next middle-aged guy who comes into my office complaining of decreased mood, exercise tolerance, low libido, sexual dysfunction, etc.  And I will likely consider Testim, since that’s what’s in the sample cupboard, thanks to the drug rep who came by last month with lunch. 😉

And the best part was getting a preview copy of the PAACT guidelines of Men’s Health Topics for the Family Doctor.  Boo ya! I love getting free stuff at these things.