Oncologist 

Saw a patient with bladder cancer who and his wife swears to me that he is cured . He is admitted with acute kidney injury and is being rounded on by oncologist and urologist daily. I reviewed his charts and found not only the cancer is still there but he also has several metastasis in spine .

What’s  going on here?

Has the oncologist not been able to break the news 

Has the urologist not been able to break the news

Is The patient and family in sweet denial.

Unfortunately this is not an uncommon scenario .

Sometimes the Doctors are not able to say words like “death” and “incurable”, especially oncologist . Sometimes the patients and their families tune out such words.

Being an oncologist is tough and being an oncologist who does not mince his words is even tougher . Still ,this patient needs a clear and open statement.

I guess I will have to be the bad guy .

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3 thoughts on “Oncologist 

  1. as a medical social worker in one of several past lives; do you have a medical social worker? If so they should love this opportunity or get out of medical social work. Then they do the probing and the news-breaking and you answer questions regarding the medical aspects. Then you get out and leave it to the SW. This is if you have them. If not; sorry. I’d start by asking what specifically the other two docs have told them. This gives you some idea of whether they’ve been told and are in denial; or that they haven’t been told. Sometimes you can’t tell anyway. If there are multiple family members present there is one that gets it but has been quieted by others. Assuming there is denial: An approach for someone in (hardcore) denial is to go with something like… I’m not here to take away anyones hope. My patient’s have told me in these situations it’s helpful to plan for the worst and hope/pray for the best. That way you are prepared for the worst; but pleased when you get a better outcome. Refer refer refer. Is this a Hospice situation? Do you have a contact there or maybe a hospice unit that has a SW? A brochure? You’re giving the news (if others don’t). Then you pass it on and move on.
    Wish I could be there to help. Odd as it sounds I love this stuff. People rise to the occasion quite often. Just regurgitating quick thoughts but I’m around to actually sort through this kind of thing if it would be of any help. Tough job.

    Liked by 1 person

    • Thanks for your advice and offer to help. I am planning for a meeting where all the doctors and family can be present. I always plan to give hope but perhaps not hope for a cure but hope for a dignified and comfortable end of life with family and friends around . Something most people in the world don’t get to have . You are right , sometimes the oncologist don’t say enough. It’s hard to face death and for oncologist it’s even harder because they are trained in the way that they want to cure everyone. I mean it’s hard for all doctors . I have shed tears several Times in my career .Still giving somebody time to get his affairs in order and say good bye to his family is important.

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      • When I broke my neck and the doctor told me I was going to be paralyzed I felt bad for him… not because he had to break the news; but because he was wrong. The denial in this one was strong. After 1.5 months in the Neuro Constant Care Unit I moved to the rehab hospital for 7.5 months (good old insurance paying for stuff in 1982). The approach at the rehab hospital was… “ok you’ll walk again; awesome. Until you do you better learn how to get around in this wheelchair.” Very go with the river, zen, blah blah; but it worked. Kubler-Ross is a great outline but I bounced back and forth between those stages even many times a day. So acceptance is something you may never see.

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