Delivering the Diagnosis, Owning the Patient

Cameron Powell cameron at PHYSICIANCOGNITION.COM
Mon Feb 15 17:37:40 UTC 2016


Ruth, I recall my amazement at an oncologist, also a surgeon, who had done some minor surgery on my mother in the past and then took over as my mother’s primary oncologist from an oncologist who retired. She assured my mother that, in spite of the two prior failed chemotherapies for her ovarian cancer, we could “get creative” and “figure something out” and the like. She was so reassuring. She gave my mother her mobile phone number. She said she’d get back to us with some ideas. We felt there was hope.

In spite of messages left on her mobile phone and at her office, we never heard from her again.

Could she have prevented my mother’s ultimate death, of ovarian cancer? It’s not likely. Could she have prevented my mother from feeling abandoned and, understandably, from re-opening very old wounds around not being good enough?

Yes. Absolutely she could have. I can’t even write any more about it.

Cameron







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> On Feb 14, 2016, at 4:01 PM, Art Papier <apapier at VISUALDX.COM> wrote:
> 
> 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 <mailto:ruthryan at COX.NET>] 
> Sent: Sunday, February 14, 2016 11:06 AM
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto: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 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 <mailto:ruthryan at cox.net>
> <image001.jpg>
>  
>  
>  
> 
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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