Posted by: notdeaddinosaur | July 7, 2008

Giving Bad News Over the Phone

How do you avoid giving a patient bad news over the phone?

This is a trick question, because the real answer is, “You can’t.”

I know how they say you’re supposed to do it: have the patient make an appointment and give her the news face to face.

Oh yeah? Let’s see exactly how that works:

Patient: Do you have my results?

Receptionist: Let me check. (finds pathology results; notices that it says “highly suspicious* for carcinoma”; hems, haws) Let me check with the nurse. (finds RN; shows results; gets told to schedule patient for MD appointment right away.) Um, yes. The doctor would like to see you to go over them. Can you come in first thing tomorrow?

Cut me a break! How much more clearly can you say “BAD NEWS!” but in the worst possible way. Now she’s left terrified — still having to wait until tomorrow.

I know, I know. Schedule all patients for return visits after all tests; no exceptions. The only problem is that makes for piss-poor customer service the 95+% of the time the results are completely negative. I sometimes fudge that by having them make the appointment, then calling them with the normal result and canceling the return visit. Still, that does nothing for the inevitable quandry of having bad results in hand with the patient on the phone.

Those waiting for me to hand down some masterful stroke of saurian wisdom are out of luck. However you cut it, this situation completely sucks, especially when the call above was to the specialist’s office and the next call was to me. The specialist’s office then faxed me the path report with a note, “Patient unaware of results; has appointment tomorrow to discuss.”

What was I going to say to her? There was no way I was going to make her feel better and the risk of making her feel worse was considerable. She was seeing the other doctor in the morning. I weighed the pros and cons and made a unique decision: I intentionally did not return the call. I don’t know if this was the right thing or the wrong thing to do, but it’s what I did; didn’t do, that is.

BY THE WAY: This is NOT how I handle these things in my own practice. I *always* call patients back with *all* results (therefore when a patient calls to see if the results are in, my staff can always say, “No; you will get a call when they are.”) When things are abnormal, I do come out and say so over the phone, giving enough information to assuage their fears until I can see them in the office and go over the everything in greater detail. But in this case, I was stuck.

Any ideas?

*In Pathology-speak, “highly suspicious for” = “is”

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