Dr. Hope

Today in clinic we had a new patient show up with a chief complaint of throat tenderness and a change in voice. Her voice had become raspy. As I questioned her about past medical history and illnesses I soon learned that she had stage 4 tongue cancer in 1996 and had extensive surgery to resect the cancer and chemotherapy. She had beat the odds and had been in remission since 1998. She had come into clinic today with these symptoms for a check up. Her husband came with her.

I figured that I should perform a nasocopy to see if I can seen what is going on with her larynx and throat. As I looked through the scope a frightful landscape unfolded. I saw cancer all around and it was furious. Before commenting to the patient I went to get my chief resident. I quickly explained the case to her and she came in and looked through the scope to see for herself. We both went and found the attending to explain the case. He then had a look for himself. The patient and her husband still did not know anything and sat there clueless to what we were seeing. We left them to discuss amongst our self what we should do next.

I mostly listened to the chief resident and the attending discuss this case. They basically said that this patient was in serious trouble and that the cancer was so far progressed that there was not much hope. The cancer not only returned but it was aggressive. We were discussing the patient in terms of weeks to months and basically they had determined it was probably inoperable. It was a sad discussion. 

Here is the interesting part; we went into the exam room after discussing the patient's impending death and the attending told the patient "we see some abnormalities in your throat and larynx and we can't be sure exactly what it is so we are going to send you to get some imaging studies. This will help us determine is going on." He said this with a smile and turned around and walked out of the exam room. The chief resident basically dodged a bunch of questions and I basically had to remain silent. The patient and her husband left to go get the CT scan we had ordered. I know they were worried but I do not think they have a real idea of how grim their life is about to become.

Why do doctors do this? Is it to provide hope? I have seen this vague type of question dodging and deflecting many times. I have tried to figure out why this is a common practice amongst many  doctors. Not all of them do this but many do it at one level or another. Obviously with today's case once we have the CT scan back and a confirmed diagnosis they will be told what is going on, however there may still be some vagueness in the doctor's explanation. I have to respect the physician's methods as the medical student but I do think about how I will handle these situations when I am an attending. I am sure there is an appropriate way to give the patient some hope while being realistic. I certainly cast no judgement at this point as I am sure my opinions will develop / change as I gain more experience. 

One take away point is that you must be an advocate for yourself as a patient and do your own research about your illness once you get the diagnosis so you can know your prognosis and options. If you arm yourself with knowledge your going to get the most info from your doctor. The more info you have will enable the doctor to better guide you. The doctor will answer your questions but you have to know what questions to ask and sometimes you may need to ask 2 or more times and do some guiding of your own.