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Dr_Dredd's avatar

Would you break bad news on a Friday afternoon?

Asked by Dr_Dredd (10491 points ) December 23rd, 2010

One of my patients was having some worrisome symptoms, so I ordered a set of blood tests. When the results came back last Friday, I saw that there was a strong probability he had cancer. I wanted to refer him to a local oncologist, but their office had already closed for the afternoon. I had a dilemma: should I inform him of the results on a Friday afternoon, knowing we couldn’t act on them until Monday when the oncologist’s office re-opened? Or should I sit on the results until Monday so that he wouldn’t worry all weekend?

What would you have done?

(The details here are deliberately vague, to preserve confidentiality.)

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25 Answers

janbb's avatar

Wait until Monday. Why let him stew all weekend when nothing can be done?

Kardamom's avatar

If there is no real problem about having the condition get worse in 2 days, then I would say, spare the patient a little anxiety and wait until Monday.

ucme's avatar

Never put off until tomorrow what you could do today….no, that ain’t right. No news is good news….no, that’s not it either. Bad news travels fast. Oh this is hopeless! Look, I believe it would be best all round to delay until it’s necessary, as has already been said :¬)

Mat74UK's avatar

I agree with @janbb wait till Monday! It’d be better all round.

marinelife's avatar

It depends. If he knows the possibilities and has been waiting for the results of the blood test, I would not make him wait until Monday.

If not, then I would postpone delivering the news.

chyna's avatar

He’s going to worry all weekend anyway. If it was me, I’d want to know.

janbb's avatar

Oh – now I agree with @chyna and @marinelife too! If he is waiting to hear and anticipating bad news, perhaps it is better to know it sooner.

Simone_De_Beauvoir's avatar

One of the oncologists I work with had the exact same issue – she waited until Monday.

Blackberry's avatar

I think I would wait as well.

Dog's avatar

Being as this week is a special family holiday for many I would wait.

cak's avatar

I am a previous cancer patient. Yes, the patient will have it on his (her) mind; however, this is a holiday weekend. Depending on how the person takes it, the timing might be so bad that it could overshadow the Christmas Holiday.—Assuming the patient celebrates
Christmas.— One thing, if you call to schedule the appointment for Monday, then the patient knows that there is news and it is gnawing at them, all weekend.

How well do you know this patient, can you gage how he will handle the news…then again, I don’t think there is a set rule on how we handle this news. I heard the first part of the discussion and then it was like someone sucked all the air out of the room. My hearing got fuzzy and really, it just didn’t register with me, until later that night.

I do not envy this decision. I can’t tell you how impressed I am that you are really taking this person’s feelings into consideration. Blessings on you for truly caring about your patient’s well-being. And continued blessings for your.

I still am leaning towards allowing this person the freedom of the Christmas holiday.

muppetish's avatar

Speaking as someone who is currently the child of someone in the hospital (but not the patient), I would want to know. If I found out the doctor had prolonged delivering the news, I would be upset. I think most people would subscribe to the ignorance is bliss camp and enjoy the holiday. I’m not in that head space at the moment. I’d want the news even if there was nothing that could be done about it. At least I would know what to expect.

It’s not an easy decision to make, though. I cannot imagine being in your shoes. This is definitely a choice that needs to be weighed on a patient-by-patient basis. My gut says the safer choice for the patient’s stress-level would be to wait until Monday.

Cruiser's avatar

Personally speaking I wouldn’t unless that time would make a difference. I was mis-diagnosed with MS on a Friday at 3:30 in the afternoon and had the worst 3 days of my life as I contemplated that possibility. A second opinion and a neurologist check up proved that A-hole Dr. was FOS! Boy was I relieved and so totally pissed at Doc #1….8 years later still am and if I ever saw him on the street…..

ZEPHYRA's avatar

Wait till Monday. He will face pain and suffering from the moment he finds out, so spare him the 2 days.

wundayatta's avatar

Doesn’t HIPPA have something to say about this? Like a patient has a right to any medical information that belongs to them?

I think that the sooner you tell someone, the more choices they have. I think that you can’t read the patient’s mind, and you can’t know what they want. Everybody is different.

I understand the urge to try to protect someone, but you can’t be sure you are protecting anyone. The patient might want to know so they could appreciate the holiday more, knowing they might not see another one.

I think you don’t have the right to make the patient’s decisions. You have to tell him or her. You can’t protect yourself from the consequences resulting from the news and the mental pain you might inflict on your patient.

BarnacleBill's avatar

I would want a game plan, with the doctor delivering the news and telling me that I have an appointment with an oncologist on Tuesday at 8:30 am for further evalution. If you can’t deliver the next step with the bad news, then wait until Monday. It would be really crappy to get a call on Friday and be told that you’re going to have to wait until Monday to find out what the next step is.

If the patient calls to see if the test results came back, they should be told the test results warrant a consultation with an oncologist.

Rarebear's avatar

Whatever you decide, don’t do it over the phone. I recommend the SPIKES protocol, if you don’t already know it.
http://theoncologist.alphamedpress.org/cgi/content/full/5/4/302
http://www.communityoncology.net/journal/articles/0202138.pdf

filmfann's avatar

Minority opinion here. Tell him Friday.
If he is anything like me, he will worry more about the possiblity of bad news during the weekend, than he would if he actually got the bad news.
If the cancer is terminal, he will have one more weekend to cherish.
He can plan ahead for the Monday meeting with the doctor.
If it was me, I would want to know. I insist on knowing bad news right away. (Godfather reference)

perspicacious's avatar

It’s the best time.

Rarebear's avatar

And in direct answer to your question, nobody here can answer it. It’s between you and your patient. Some patients I would wait and some I would tell. It really depends.

john65pennington's avatar

I have a comeback question, first. have you ever received a piece of mail on a Friday afternoon, that was a bill that was not yours? you know how anxious you feel. its late Friday and you cannot contact the sender, in order to set the record straight. all weekend you steam at a bill that is not yours and there is nothing you can do about it, until Monday. it ruins your whole weekend.

In this situation, the reverse applies. No, do not tell him and make him worry the whole weekend. there is nothing he can do about it, until Monday.

cak's avatar

@wundayatta: HIPPA doesn’t mean doctors get test results and run to you with the results. HIPPA protects your privacy, among other things. I had to wait days for results; in fact, I’m on the second week of waiting for a test result. I’m sure the holidays have some factor in this delay.

There is worry on either side of the fence. Knowing and not knowing. I’ve been on both. I just know that I would want a peaceful holiday without knowing. Sure, it’s still on my mind, but just being around family takes some of that worry away. I found out bad news right before a holiday before, it was extremely hard to focus. There just isn’t a perfect answer to this question.

janbb's avatar

@cak You are so wise, sweetie!

cak's avatar

@janbb: not wise, just been there, but than you.

chyna's avatar

@Dr_Dredd I’m sure whatever you chose to do, it turned out to be the right way to handle it.

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