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Spoke w/ a junior resident about a tough case. He asked: How do you tell someone they have cancer? How do you comfort them?
I won& #39;t pretend to be an expert but explained to him my approach and I& #39;ll share one element for #medtwitter users who might find it helpful. A
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I won& #39;t pretend to be an expert but explained to him my approach and I& #39;ll share one element for #medtwitter users who might find it helpful. A
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1st- this is a huge topic. @SAEMonline has some great resources on breaking bad news. But each situation will always be different. There are so many variables and so much nuance- all of it way beyond the scope of a few tweets.
2nd- a cancer dx (or strong suspicion for it) shouldn& #39;t ideally come from the ED. Unfortunately, at my safety net hospital it is not uncommon. This reflects many issues with our healthcare system (cancer care in particular)- also way beyond the scope of this thread.
Worth quickly noting: ED cancer dx is associated with later stages and increased mortality. This study from @MontefioreNYC is illustrative:
https://pubmed.ncbi.nlm.nih.gov/29108643/
https://pubmed.ncbi.nlm.nih.gov/29108643/... href="https://twitter.com/IanSolsky">@IanSolsky @MontefioreSurg
https://pubmed.ncbi.nlm.nih.gov/29108643/
But say you& #39;ve given a (likely) cancer dx and in addition to coordinating next steps- outpt f/u, sometimes admission, more testing- you want to offer some minor reassurance (NOT false hope or foolhardy prognostication). What is there to say?
First, I like to stress to patients that they did the right thing coming to the ED πππ
ππ. Even if it& #39;s wide spread and we wish they& #39;d come in sooner. The pt also could& #39;ve waiter longer and didn& #39;t.
Cancer can make people feel powerless. I want to reinforce their agency.
Cancer can make people feel powerless. I want to reinforce their agency.
Second, I talk about our specialists and the road they took to become experts. That I& #39;m going to consult/refer to someone who is very smart and knows infinitely more about malignancies than I do.
And I& #39;ll spell it out. I& #39;m entrusting someone with your care who...
And I& #39;ll spell it out. I& #39;m entrusting someone with your care who...
Was an excellent high school student. Then an excellent college student. Who busted their behind and went to medical school for 4 years. Then studied internal medicine for three years where they spent countless hours confronting problems like yours.
Then they did a fellowship for πππππππ three years to develop expertise treating cancer. And many go on to complete even more specialized training and research. A πππππππ of ten years of training after college to even have the opportunity to care for you.
(A similar convo plays out for surg onc.) Ultimately, I am not just referring a pt to someone who knows more about cancer than I could begin to imagine. I am sending them to someone who has devoted their ππππ to understand and combat this disease.
And if you& #39;re going to have someone helping you to navigate a challenging time and scary disease, that is πππππππ who I& #39;d want on my team.
Of course, this isn& #39;t meant to ameliorate cancer diagnoses. But if conversations like this can offer even a small measure of reassurance- or make the next steps in cancer care seem just slightly less intimidating- I& #39;d argue it& #39;s a worthy endeavor.
But I& #39;m also interested to hear if anyone else on #medtwitter has unique approaches to these sorts of conversations in the ED. I would love to get any insights you all have to offer.
Photo credit: @JeffStapleton
