White lies?
There are many, many things that I like about my 'job' (or that I will like when I am a practicing doctor). I like interacting with patients and their families, I like making a difference in peoples' lives, and I like the medicine. Giving bad news is not one of the things I like.
Today, I had to tell a patient about their HIV status. HIV tests are done in 3 parts: screening test, supplementary test, and confirmatory test. My patient had all 3 come out positive (so they have a new diagnosis of HIV), but so far we've only told them about the screening test (I told her that we're waiting until tomorrow to get the final results). Before I receive a hundred comments about how evil that is not to tell the patient the whole truth yet, here are my reasons for only disclosing part of the truth now:
1) I wanted to guage how the patient will react and give them a chance to tell me their concerns and ask any questions
2) I wanted to offer the patient a chance to arrange to have a loved one come to the hospital to hear the final results with them so they can offer moral support.
3) I needed more time to get the HIV social worker informed so she is prepared to see the patient soon afterwards.
4) I wanted to give the patient more time to think about what they may want to ask us tomorrow.
Having said all of that, if I was in the patient's position, I would just want my doc to be straight up with me and lay it all out on the line. None of this beating around the bush crap. Then you wouldn't have any of the worrying that you have HIV or hoping that the final result may be negative. Part of me wishes I had just told her all of it, but I thought a lot about how I wanted to handle this and it was the reasons above that I chose my actions, right or not.
Even though giving bad news is part of the job and I need to learn how to do it, I am acutely aware that it takes practice to do it well. Being a medical student and having all these 'first' experiences makes me feel sort of bad for the patients. Us med students are essentially using some patients as guinea pigs (i.e. I'm going to practice giving bad news today). I take comfort in the fact that I know I care about my patients and I have developed a rapport with them while they've been in hospital so they're not hearing it from a total stranger. That doesn't make it any easier...for them or for me.
Today, I had to tell a patient about their HIV status. HIV tests are done in 3 parts: screening test, supplementary test, and confirmatory test. My patient had all 3 come out positive (so they have a new diagnosis of HIV), but so far we've only told them about the screening test (I told her that we're waiting until tomorrow to get the final results). Before I receive a hundred comments about how evil that is not to tell the patient the whole truth yet, here are my reasons for only disclosing part of the truth now:
1) I wanted to guage how the patient will react and give them a chance to tell me their concerns and ask any questions
2) I wanted to offer the patient a chance to arrange to have a loved one come to the hospital to hear the final results with them so they can offer moral support.
3) I needed more time to get the HIV social worker informed so she is prepared to see the patient soon afterwards.
4) I wanted to give the patient more time to think about what they may want to ask us tomorrow.
Having said all of that, if I was in the patient's position, I would just want my doc to be straight up with me and lay it all out on the line. None of this beating around the bush crap. Then you wouldn't have any of the worrying that you have HIV or hoping that the final result may be negative. Part of me wishes I had just told her all of it, but I thought a lot about how I wanted to handle this and it was the reasons above that I chose my actions, right or not.
Even though giving bad news is part of the job and I need to learn how to do it, I am acutely aware that it takes practice to do it well. Being a medical student and having all these 'first' experiences makes me feel sort of bad for the patients. Us med students are essentially using some patients as guinea pigs (i.e. I'm going to practice giving bad news today). I take comfort in the fact that I know I care about my patients and I have developed a rapport with them while they've been in hospital so they're not hearing it from a total stranger. That doesn't make it any easier...for them or for me.
posted by MSI (Med Student Intern) @ 5:19 PM
1 Comments:
At 8:51 AM,
Anonymous said…
I think sometimes medical students are better at breaking bad news, it is new for you so you are more aware of what you are doing, the seriousness of the situation etc. Because of that I think you come across as more genuine.
I have seen many staff say things like "It looks like it's cancer" or "you miscarried" and then close the door for any discussion. Good luck.
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