Delivering the Diagnosis, Owning the Patient

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Sun Feb 14 19:01:57 UTC 2016


Ruth, All that you describe is so familiar to me in my own situation, and
multiplied endlessly in the kidney cancer forums in which I participate.
Perhaps the simplest story of abandonment comes from the surgeon who says,
"I got it all, and you are fine".  No monitoring, no reference to the
pathology and no reality as to the size of micromets and the potential of
spread beyond the area of the incision.  The PCP assumes the patient is
well-cared for by the surgeon, often a urologist, but rarely is directed to
an oncologist.  "Don't need an oncologist; I got it all".  And the patient
who insists on seeing an oncologist is seen as over-anxious, distrustful of
the experienced doctor, and sadly, at greater risk than he realizes.

Let me know if you need more stories; there will be a new one in the
morning's email.

Peggy

Peggy Zuckerman
www.peggyRCC.com

On Sun, Feb 14, 2016 at 8:06 AM, Ruth Ryan <ruthryan at cox.net> wrote:

> Also in the NY Times today, an article titled “Death, the Prosperity
> Gospel and Me” begins like this,
>
>
>
> “On a Thursday morning a few months ago, I got a call from my doctor’s
> assistant telling me that I have Stage IV cancer. The stomach cramps I was
> suffering from were not caused by a faulty gallbladder, but by a massive
> tumor.” The writer went on to say she fell to her knees and cried, she
> called her husband, she was 36 years old, her world became very small.
>
>
>
> I was still stuck re-reading those words “a call from my doctor’s
> assistant telling me I have Stage IV cancer.”
>
>
>
> It reminded me of my 43 year old daughter-in-law’s experience when her
> lung tumor was found by a pulmonologist. He told her it may be isolated and
> able to be surgically removed.  After the PET scan, Julie received a call
> that went like this,
>
>
>
> Caller: “Hello, I’m calling from Outpatient Registration. The doctor has
> scheduled you for 4 MRIs on Tuesday at 2 pm.”
>
> Julie: “4 MRIs, why 4? MRIs of what?”
>
> Clerk: “Well let’s see, there’s an MRI of the left clavicle, the spine,
> the right femur and…” (by this time Julie didn’t hear or recall the 4th).
>
> Julie: “Does this mean my cancer has spread to all those places?”
>
> Clerk: “I don’t know, I’m just the scheduling assistant. You’d have to ask
> the doctor.”
>
> Julie: “May I speak to the doctor?”
>
> Clerk: “Well, he’s not here, I’m not calling from his office, you’d have
> to call his office.”
>
> The doctor was at a conference in Europe, and no, nobody else in the
> office could speak with her.  She’d have to wait till he returned.
>
>
>
> The IOM Report on diagnosis rightly defined diagnostic error as including
> failures in communicating the diagnosis to the patient.
>
>
>
> I’m creating a CME film about the abandonment of patients that goes on
> with a poor prognosis.  It often begins with the diagnosis. Abandonment can
> involve multiple specialists in siloes with no one physician being “in
> charge”. It happens in the devastating weeks following cancer diagnosis:
> the original diagnosing physician waits for the oncologist to take over
> ownership of the patient, while the oncologist will not schedule an
> appointment until all the tests are done, consultants consulted, and biopsy
> results reported. It happens near the end when the oncologist, often only
> days before death, refers to the patient to palliative care or hospice….
> and frequently terminates contact with the patient and family thereafter.
>
>
>
> I’ll be collecting stories about the various forms of patient abandonment
> at end of life.
>
>
>
> *Ruth*
>
>
>
> Ruth Ryan RN, BSN, MSW, CPHRM
>
> Medical writer
>
> Risk management/patient safety
>
> Continuing medical education
>
> Telephone (504) 256-8797
>
> Email ruthryan at cox.net
>
> [image: canstockphoto14944494_revised]
>
>
>
>
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


HTML Version:
URL: <../attachments/20160214/32330c77/attachment.html> ATTACHMENT:
Name: image003.jpg Type: image/jpeg Size: 2723 bytes Desc: not available URL: <../attachments/20160214/32330c77/attachment.jpg>


More information about the Test mailing list