Monday, March 21, 2005

Thanks For Nothing....

The scenario where a doctor tells a patient that they have cancer is an oft-discussed classic situation. It's the subject of many jokes, but I can assure you there's rarely anything funny about being the doctor concerned.

General practitioners don't often have to give this sort of bad news. That's not to say that they don't frequently see patients with cancer: in fact, they are usually the first person to suspect it. Confirmation of the diagnosis tends to require investigations, and these tests are generally carried out by, or are only readily available to, specialists in secondary (hospital) care. Once the tests have proven the diagnosis, it generally again falls to the consultant to tell the patient the result with somewhat variable sensitivity and communication skills.

Recently a lady in her 50s, who rarely consults, attended my surgery complaining of breathlessness and a cough. She had otherwise been reasonably well. I examined her chest, and did a simple test of her respiratory function. This test showed a very low result, and I told her I suspected she had chronic bronchitis and emphysema, which are sometimes diagnosed late because the breathlessness comes on over a very prolonged period. I gave her an inhaler to try, and later some oral steroids. I decided to get a chest x-ray to see if this confirmed emphysema. In fact, it showed what is almost certainly a right sided lung cancer. This may have already spread to her bones.

When she came for her follow-up appointment I was a bit apprehensive. It's one thing giving this sort of news when you think the patient expects it, but it's another when you've led them to expect a more benign diagnosis. She came to the appointment on her own, and it didn't seem fair for her to get news like this without the presence of, for example, a family member for support. In fact, when I told her what was suspected she actually smiled and told me she was not at all surprised! She had been feeling unwell for a while, and she was relieved to know at last what was wrong.

I think her prognosis is likely to be poor, but at least we've now identified the enemy she must fight against. She seemed to feel that was something worth thanking me for.