Delivering the Diagnosis, Owning the Patient
apapier at VISUALDX.COM
Sun Feb 14 23:01:03 UTC 2016
Ruth, This is important work. Have seen this happen unfortunately way too
much. Hope your mardi gras was a good one. Art
From: Ruth Ryan [mailto:ruthryan at COX.NET]
Sent: Sunday, February 14, 2016 11:06 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [IMPROVEDX] Delivering the Diagnosis, Owning the Patient
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
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 Ryan RN, BSN, MSW, CPHRM
Risk management/patient safety
Continuing medical education
Telephone (504) 256-8797
Email ruthryan at cox.net <mailto:ruthryan at cox.net>
<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine
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