Breaking the News


From the March ACP-ASIM Observer, copyright © 2003 by the American College of Physicians-American Society of Internal Medicine.

Breaking not-so-bad news

Your story offering advice on breaking bad news to patients reminded me of an incident that happened decades ago when I was working in a community clinic. ("Bearing bad tidings? Try these communication strategies," January ACP-ASIM Observer.)

I saw a couple who had been married for 45 years. He was a retired dentist who had suffered a stroke but could walk with a metal quad-cane. When I looked through his medical record and picked up the radiologist's report for his chest X-ray, it said, "lung mass."

Before breaking that kind of news, I wanted to see the film myself. I excused myself, went to the radiology department, put the film on a lightbox and consulted our radiologist physician-to-physician.

As he described the lung mass in deep, stentorian tones, I noticed that while the first and last name stamped on the film were the same as my patient's, the middle initial and identification number were different. It turned out the X-ray of my patient, the retired dentist, was perfectly normal.

I returned to the exam area, sat down and fully explained the error to my patient. I watched as the patient and his wife of 45 years communicated without words. They had been married that long! They smiled, nodded and thanked me for my thoroughness and candor.

To this day, I don't know how I could have done any less and still comply with the College's guidelines on professionalism.

Joshua Grossman, FACP
Johnson City, Tenn.