By Dr Dan Simpson, Scotland.
I remember an interview question for entering medical school: “Why do you want to be a doctor?” “To diagnose, to treat and hopefully cure”.
My younger self was seemingly oblivious to all the other ways health workers can help people, care for them and simply offer them comfort in difficult times.
Providing a cure comes with immense satisfaction. The man who was overtly septic is now well and going home. The lady who had a stroke yesterday and was unable to speak is now chatting happily from her chair due to the apparent miracle of ‘clot busting’ treatment. This was the ‘helping of people’ I aspired to. What, though, for those in whom cure is less likely?
Occasionally a result is received where a poor outcome seems most probable: A cancer with spread to multiple parts of the body. An oncologist may be able to offer some treatment to prolong life but the odds are stacked heavily against a cure. Referrals can be made for options to be explored but for now the duty is to look the patient in the eye and inform them their worst fear is being realised. They have cancer and it has spread.
The consultation starts like any other with benign chat about the weather, about how busy the ward is, about pets at home, about anything at all as doctor and patient seem to subconsciously conspire to delay the real focus.
Then a change in tone like an awkward segue in a news entertainment programme. “I have just been looking at the result of your scan”. I try not to rush the news but equally do not want to give unnecessary and cruel delay. “I’m afraid the news is not good”.
In communication tutorials this sentence would be called a “warning shot”. A tactic to soften the real grit about to come. The change in the patients expression conveys an immediate realisation. This is no warning shot. It is the confirmation of all their fears and all that follows must feel a blur.
The conversation is a fine balance in trying to convey the situation accurately but without removing hope. No matter what hope can still exist. A cure may not be available but we can still help them. There may be treatment to slow their decline, they need not be in significant pain or discomfort, they need not feel overly sick or nauseated, we can put them in touch with people who can counsel them and prepare them and their families for the worst.
If nothing else we can share in their grief and offer some comfort.
My work in medicine has so far felt very privileged. Surprisingly this has been best demonstrated whilst breaking bad news like a diagnosis of cancer.
The privilege is not necessarily in offering a cure; it is in getting to be there for people, to help in anyway possible, in the best and worst times of their lives.