Friday, March 09, 2012

How Not to Discuss a Biopsy

Now I can tell this story. Now that she has the result, and the result is that it's not malignant.

The story is about someone I care about very much, and it happened abroad, in one of Europe's most civilised countries.

Not, of course, that it couldn't have happened in Britain. There are idiots everywhere, and sadly some of them slip through the net and get to be doctors. Though, I hope, fewer than in previous years.

I will call her Helen, though it's not her name.

Helen had found painful lumps in her breast, and after several doctor visits she had had a biopsy at the hospital. Just in case you don't know, a biopsy is where they take a sample piece of your body and analyse it, usually to see if it is malignant: to see, in other words, if you have cancer. So nothing trivial then.

The biopsy was incredibly painful. Helen tried to explain to the person doing it that she was worried that it would hurt a lot, and the reply was a brusque "Well, lie down, it's got to be done." Perhaps the person who did it thought that they had to be assertive, rather than empathic.

Of course, all this happened in a language which was not Helen's first language, although she is totally fluent in it.

So, a week later, Helen went back for the result. She was, understandably, very frightened about what the biopsy might show, so her husband and two friends went with her.

They had to wait an hour and a half, because the clinic was running late, and then went in to see the doctor.

The doctor embarked on one of those long accounts of the Story So Far, going back roughly to the beginning of the universe.

"So, Mrs Johnson, you first found a lump back in August last year, and you went to the doctor, and he said - - "

When you are waiting for news of any kind this sort of prevarication is never helpful. Although the doctor can justify it by saying that he's preparing the patient for the news to come, I would disagree with this. What he's doing is going on and on and on because he can't bring himself to tell the news: it's not for the patient's benefit, it's the doctor being selfish. The more he goes on, the more you know that the news is going to be bad.

And finally, getting to the point, the doctor said "And I'm afraid that I have to tell you that the news is not what we would want."

So Helen clutched her husband's hand extra hard and waited for the word "malignant".

Instead, she got "I'm sorry to tell you that we lost the biopsy."

And she barely had time to think "WHAT?" when he continued, cheerily, "But the good news is, we found it this morning. But you won't be able to get the results for another week, so you'll have to come back next Monday."

Stunned, Helen went home. The person who had lost the biopsy sent her a bunch of flowers. It didn't help.

So - - - what SHOULD they have done? Well, ideally, not lost the biopsy, of course.

But, having lost it, if they knew before Helen left the house that morning they should have rung and told her, and asked her not to come to the hospital that morning, and apologised like crazy.

Or, failing that, they should have moved her to the front of the queue and got her in to see the doctor early, before she'd had to wait for an hour and a half.

And if none of that was possible, then this was an occasion to go STRAIGHT to the point. When breaking bad news, doctors are trained to deliver a "warning shot" of something like "I'm sorry, but it is bad news" to give the patient that second to prepare themselves.

But this was not bad news. It was NO news. So anything beginning "I'm sorry - - " would make Helen assume the worst.

So what was needed was an initial "There is no news" and then an "I'm so sorry" and then an explanation of why.

But what Helen got was something best described as mental torture.

When I heard this story I was both very sad and filled with rage at the stupidity, the lack of empathy, the lack of humanity in the way that this was handled.

I often wonder what I would do in any given situation if I were In Charge. Because of my work in Communication Skills with doctors and nurses I think I have the right to shove my oar in here - - but honestly, anyone with a shred of human feeling would know that the above was a truly appalling way to behave.

If I were in charge of this doctor, I would suspend him instantly, and indefinitely. Then he would need substantial retraining with particular emphasis on feelings and empathy. And it wouldn't be just tokenism - I would want him closely watched for a long, long time. If he didn't improve, I would sack him.

As it is, he's probably traumatised several women since that particular incident, because it was a few weeks ago now. Stupid, thoughtless, uncaring bastard.


Anonymous Ruth said...

Horrible horrible horrible.
I really hate the 'Story so far' thing that doctors tend to do. Occasionally they ask confirmatory questions - when you've told the same medical history a zillion times and know they have it written down in front of them in the copious medical notes about you - it is so tempting just to say you've got it written down there, why don't you tell me?
I am so so sorry 'Helen' was put through that. I am very glad that the result is that it's not malignant.

9:01 pm  
Blogger Silverback said...

I'm amazed that 'Mr. Helen' didn't give Dr. Bastard a right good slap.

I remember seeing a movie where a self centred, uncaring surgeon became a patient in his own hospital and had to endure the anxiety and powerlessness that every patient experiences. It certainly changed him for the better.

Clearly this doctor hasn't had that experience yet so as a stop gap, he needs to have a biopsy done on his testicles.

9:57 pm  
Blogger Helsie said...

Totally agree. You've said it all.

6:44 am  
Blogger Daphne said...

Ruth - yes, although doctors always try to justify doing that, in my opinion it's always either laziness or cowardice, or both.
Silverback - I think that Mr Helen was also too shocked to do the obvious thing - which was to hit Dr Bastard very hard indeed! As for that film, I want every doctor to see it twice - once when they start medical school and once after they've qualified.
Helsie - thank you. I think there are very many brilliant doctors about, with excellent communication skills: but I think we as a society are far too ready to put up with the dreadful ones.

9:53 am  
Blogger rhymeswithplague said...

So why don't you tell us how you really feel....

Although I can certainly empathize with your friend, I think you are overreacting just a tad. Sack him? Indefinitely? With all that medical knowledge and training? (lacking in one area, of course, that of communicating with the patient)

There is enough physical pain and disease and misery in the world that it needs all the doctors it can get, even if some of them have poor communication skills.

Take a step back, breathe, and rethink your conclusion, Daphne!

Perhaps the doctors should be made to understand that their "First do no harm" dictum applies to mental and emotional harm as well as to bodily harm....

1:07 pm  
Blogger rhymeswithplague said...

In our country, of course, the woman would sue the practice for losing the biopsy and for causing her much emotional harm. And she would probably win a huge sum of money.

1:11 pm  
Blogger Daphne said...

Bob - well, as I said, I'd try retraining first. But if that didn't work - yes, I would sack him - because doctors who lack empathy tend not to care about their patients and hence tend to be bad at other areas of the job too. I'd hope that in the future, fewer of these doctors will qualify - and actually, certainly in Britain, I think that's already the case, because of increased emphasis on communication skills in training.

10:10 pm  
Blogger Katherine said...

That's so awful Daphne. I can't believe the doc was so bloody insensitive. Incredible tale.

10:33 pm  

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