“So you’re perfect?”
“Unfortunately, you’re CT isn’t perfect.”
Today in clinic, I had to tell a family that there is a new nodule in their child’s lung.
After the family left, the fellow who follows this patient with me asked, “How do you decide how to break news like that to them?” An excellent question. I’m not sure I have the answer.
When I was a younger oncologist, I would never have just come out and said, “Your scan has something bad on it.” I’d have worked up to it, emphasizing how well the patient is doing (assuming that’s true), and ultimately would try to use a more gentle euphemism when first breaking the news. I’d also ensure that by the end of the discussion we had moved beyond euphemisms and were speaking frankly about what the scan showed, but initially it somehow used to feel easier to start out softly.
More recently, I’ve found myself just coming right out and saying it. Bluntly.
I don’t know which is the better approach. I think that once one of my patients has a scan, the parents can’t think of much else other than what it shows. I think that approaching a bad result softly, with euphemisms, just delays the inevitable, and doesn’t really change the impact of the bad news. I wonder if it even makes it worse somehow, because as I’m saying something other than what the scan showed, I may be drawing out the anxiety and making things worse.
Of course, I’ve been blessed not to have ever been the parent of a child with cancer. How would I want the doctor to break news like this to me? I’m just not sure.