Thursday, November 6, 2008

It’s Good to be Wrong

Sometimes my job is tough, especially when I have to give someone bad news. In September, I described telling a child and his family about a new nodule on his CT scan. Ordinarily, such a nodule means metastatic disease. Metastatic disease is an ominous sign.

In that post, I talked about how to deliver bad news. What I didn’t mention was our discussion of alternative explanations for the CT scan findings. Although I told the family that this nodule probably represented a return of the cancer, I also told them it could also be caused by inflammation, infection, or some other benign process.

Was this false hope? Was I just trying to soften the blow? Or could it really be that the nodule we saw was caused by something else?

We decided not to act immediately, but to wait a brief period and repeat the scan. If the nodule was cancer, it should still be present, and it should be larger. If it was inflammatory, it could be gone.

Three days ago we repeated the scan. The radiologist’s report reads, “Interval resolution of previously visualized nonspecific 2 mm nodule.” The nodule is gone!

I had told the family I thought the cancer was back. I also told them I hoped I was wrong. Sometimes, it’s good to be wrong.

Related Posts:
A Concerning CT
When Chemo Works
The Surreal Life
Giving Bad News Without Destroying Hope

4 comments:

Jen said...

That's awesome news. It must make you feel pretty good to be able to pass that on to the family.

rlbates said...

I agree -- sometimes it's very good to be wrong. :)

Dr. Val said...

Whew. Now that's a relief. Of course, radiology reports of all stripes can be over-called, causing additional anxiety for patients. Take the mammogram for instance - shadows, dense breast tissue, incomplete visualization of breasts, etc. can all be called "abnormalities." I worry about the anxiety we cause our patients in these cases. :)

Doctor David said...

All too often, bad news is what I give families...so, yes, it's great to be able to give someone good news.

Dr. Val, our families who have these routine scans use the term "scanxiety" to refer to the period just before and just after scans, when they are more acutely worried than normal about the possibility of relapse. Whenever I give scan results, unless there is absolutely no alternative explanation, I always leave open the possibility that a "nodule" is really nothing. What was great in this case was the reinforcement that sometimes a nodule really IS nothing, and when I say that to a family, I'm giving them realistic hope.