Wednesday, 22 April 2009

I Shouldn't Be Here!

Happily walked into a respiratory outpatient's clinic the other day.  The consultant I was with was a bit crazy but they all seem to be in some way.  The Vascular Surgeon I'm going to be with in 4 weeks time will not pay me any attention, in fact he might send me home, if I don't wear a tie!

Back to the clinic.  There were several patients seeing the Consultant for various diseases, Tuberculosis, Chronic Lung Disease, etc.  There were a couple of patients there to receive a confirmation of a diagnosis of lung cancer.  Lung cancer is one of the really bad cancers, they are all bad of course, but many offer good prognoses with current treatment and many people can survive it nowadays.  Lung cancer, however, remains stubbornly resilient to treatment and more importantly early diagnosis.  Early diagnosis is the key to curative treatment in most if not all disease.  Because of this the 5 year survival for lung cancer is around 5% and has been that way for a while.  So most patients will understand that being told they have lung cancer has a major impact on their lives.

So, a patient came in who was wheeled in on her wheelchair by one of her daughters followed swiftly by another daughter wheeling in the patient's husband.  Now the husband had already been diagnosed and treated for terminal prostate cancer.  By some weird trick of fate I ended up sat in the middle of the family, from left to right it went - patient, daughter 1, me, daughter 2, patient's husband.  As the consultation went on the consultant gave the diagnosis and I suddenly felt very aware that I was sat in the middle of all of them!  I have never wanted to run so much in my life!  Partly for me because I was weirded out and felt like a gooseberry but mostly because I felt I shouldn't be allowed to just sit and watch a moment like this, it's too personal!

Truth is though, that I have to be there.  Doctors of every speciality have to be able to break bad news well and sensitively.  It is a learning process and requires a lot of observation of senior colleagues who have done it many times before.  Get it right and you can help people through a very difficult time, get it wrong and you have an already sad patient who is angry and shocked to boot.

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