I met a wonderful patient – a very bright, almost-retired internist who had trained at Johns Hopkins back in the days of the giants. He is elderly but very active, and was severely pancytopenic. He expressed many times that he hoped it was not bad, as he dearly loves his wife/children/grandchildren, and is expecting more grandchildren. I told him the truth, that I suspected myelodysplastic syndrome/acute myeloid leukemia. His marrow shows 18-20% blasts, and he’ll be coming back in to discuss his results. He has asked me, “I hope I can live at least a few more years, what do you think?” and I will tell him the truth that it’s possible but not probable, but feel like I’m letting him down by delivering this news.
On another occasion, one of our referring PCPs with a history of cancer in remission walked into our office saying he didn’t feel well. I chatted with him and said, “You probably have liver metastases with carcinomatosis; we’ll get a stat CT.” He ended up being full of liver mets/carcinomatosis, so I gave him this news, explained he was incurable, and needed to think carefully about his future. He is on chemotherapy and fortunately still well enough to practice, and periodically says that he believes he will be cured with chemotherapy.
How have your MD colleagues generally accepted bad news relative to your general patient population, and how has this affected you? Any hints to make these interactions better for our colleagues?
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