Posted by: notdeaddinosaur | September 20, 2014

Timing

The history was concerning. The exam was alarming. Labs were sent; imaging ordered; possible diagnoses, including dire ones, were discussed at length. A hug was offered and accepted, and the patient left with assurances that I would call just as soon as I knew anything.

The next day the radiologist called, which is never good. It wasn’t. Then the labs popped into my inbox. All the information was back. It was time to call the patient.

But I didn’t.

Why not?

It was late Friday afternoon, and I made the conscious decision to not make the call right then.

Here’s how I looked at it: either the patient got to spend the weekend not knowing, or knowing the worst but not being able to do anything about it for three long days. I elected not to ruin the weekend.

Was I right? Was I wrong? I don’t know.  I asked myself how I would feel getting that kind of call late on a Friday, and that’s how I decided. It was my call, for better or worse.

First thing Monday morning I’ll pick up the phone and make the calls to the patient, the surgical oncologist, and do whatever else it’ll take to get the ball rolling. Surgery will likely ensue within days; the surgical oncology group is really good about not making people wait.

But for the moment, I’ll carry the burden of knowledge alone, letting my patient enjoy a beautiful weekend. Well, as much as possible waiting for this kind of news.

What would you have done?

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Responses

  1. I agree with your call! I hate to get bad news late Friday afternoon when I can do nothing about it. Don’t lose your own sleep over the weekend, either. You did the right thing.

  2. You made the most compassionate and right decision possible. That kind of news is best received when given with a clear plan of what to do next. When I was that patient I could only deal with what was the next appointment, what was the next treatment. Any more than that would have drowned me.

  3. I think you did the right thing. I would hate to get that kind of news and not be able to do anything about it for three days. I would much rather get a call on Monday when I can start making appointments or do whatever I had to do next.

  4. I am not sure…at first I thought I’d do what you did, but then I thought that the decision probably needs to be based on who the patient is and how that person deals with things. Perhaps if the patient had known on Friday, he/she could have had some time on the weekend to spend with family processing what might be happening in the near future…but whatever you do or did will work. If I was the patient and you said you’d call on Friday, I’d want a call, even you called and said you didn’t have any answers yet…good question.

  5. I would have made my decision the same way you did, based on what I would want, but that would lead me to call the patient. I’ve been on the patient end of waiting for results and it is maddening; my imagination is capable of creating far worse scenarios than any actual test results, and I would have appreciated having the weekend to calm my emotions & do some research on my diagnosis. Ideally you’d know the patient’s preference but if not, the best you can do is what you did: make the best call you can based on empathy.

  6. I’ve had the same dilemma. I’d tell her as soon as I knew. I think nothing is worse than waiting. Unfortunately, what usually happens is that I get voicemail when I try to call, and leaving message is worse than not calling at all.

  7. I would have, and have done, the same thing.

  8. Waiting is miserable. Bad call on your part, IMHO.

  9. I think either decision is justifiable. If you would be unable to take any action on the patient’s behalf late on a Friday, then waiting until Monday when you could outline the steps that you would take immediately may have been best. Everyone is different about learning this kind of news. Some people might have preferred to receive the news on a Friday so that they would have the weekend (presumably off work) to digest the knowledge. I would have wanted to know right away, but I’m the kind of patient who knows how to interpret journal articles on medical issues. So I could weigh the evidence for myself, helping to inform my decisions in the following days. Someone who reacts fearfully and doesn’t have the same skill set might feel hopeless and fearful all weekend. In the end, I think what matters is that you made a decision based on *kindness,* and no one can argue with that. I’m sure your compassion will come through to your patient.

  10. What Odyssey said: I would have, and have done, the same thing. Some years ago it was discovered that my husband had a tumor right before 4th of July weekend. We were called Friday afternoon, so that made for a 4 days weekend before we could see the surgeon. Ultimately he ended up doing OK, but I wish we could have waited until Tuesday morning for the news. It was a miserable 4 days, I can tell you.

  11. Question is: do you let the patient worry over the weekend about what the results of tests might be? Or, give the results immediately and let them worry about the bad diagnosis? It depends on how you judge the patient and their expectations. Under most circumstances I would tell them on Monday.

  12. Having been on the other end, getting news on Friday of a three day weekend: don’t wait.

    (Start of our story here, if you are bored: http://ruthann.the-valentines.org/2009_03_01_archive.html)

  13. I know this is an older post. But as a patient I’d like to thank you for thinking about it.

    Several years ago I had to have a routine mamogram. Results a week later “can you come back in for more, we THINK its the scar tissue but need to be sure”. After the second set they had me wait while they checked the scans. All clear, no problems!

    Several days later, on Friday afternoon while I was working, my regular doctor’s nurse left me a voicemail “please call us back about the results of your mamogram”. And of course by the time I COULD call back they were gone for the day.

    I spent the weekend POSITIVE that they’d changed their minds and something was wrong…..

    Turns out the regular office hadn’t been notified that I’d already been given the results and just wanted to let me know it was all clear. The nurse apologized when she found out what I’d thought.

    As a patient I certinally want the results as quickly as possible. But a voice mail I can’t return, on a day where I’ll have to wait three more before I can talk to someone, is pretty close to hell.

  14. Thanks for the props, Ruth. As can be seen from previous comments, it’s a high stakes balancing act. Glad you felt I came down on the right side.


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