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Dealing With Bad News From Your Doctor

Feb 19 12:43pm

I've had a couple of visits with my doctor recently that left me a bit lost. First, I got news of an abnormal X-ray result and then, a month later, a disappointing ultrasound result, disappointing because it didn't show what my doctor had hoped to see.

This experience has heightened my awareness of how I communicate unclear or bad news to my patients, and it's got me wondering whether I take enough time to explain to patients their results and the implications of tests.

I'm certain that after they leave my office, many patients will still have more questions occur to them, and I wonder now whether they know how to go about getting answers.

Why would results be unclear? Because there are few medical tests that provide a clear-cut, yes-or-no answer. Most assessments will instead result in shades of gray and will need to be correlated to your symptoms and exam findings. Also, many radiologic tests will reveal findings referred to as "incidentalomas"—findings that are a variant of normal or that could also indicate an abnormality, but in any case have nothing to do with the reason the original test was done.

Other tests are affected by the time at which they are done; for instance, blood sugars and cholesterol values are higher after eating, and hormone levels fluctuate throughout the course of a day or month.

So what should you do if you have medical tests on your horizon?

  1. First, understand what test is intended. Is this test necessary? What are the risks of the test? Pain? Radiation? Possibility of a false-positive or false-negative result? (That's right—most tests are not 100 percent accurate!)
  2. Next, have a plan for obtaining the results. Is there a set time to call, or will the doctor call you? Would it be better to schedule a follow-up appointment in case you have questions or the results are upsetting?
  3. Consider how you will react to good or bad results. Feel free to express your reaction, while remembering that your doctor is neither likely to experience your emotional response to the results, nor anticipate your reaction. "I'm angry/sad/scared about this test," or "I really didn't see this coming," are appropriate responses and will remind your physician that your abnormal test is not an ordinary event for you.
  4. Write down any questions that come up after the appointment and prepare a strategy for your care going forward. If you get home and questions are flooding your mind, write them down. Consider sending the list to your doctor ahead of an appointment; that way, she'll be able to prepare responses.
  5. Be clear before you leave the doctor's office as to what steps you'll need to follow to be at your healthiest.

Good luck!

4 Comments Report Abuse
1. marcialweeks - Feb 24 08:23pm
This hasn't helped me at all. but thanks anyway.
2. investdia - Feb 28 04:39am
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3. jobearbyrdsong - Apr 27 02:39pm
This strikes a particular cord with me. I was being tested for Hep C. When the doctor got the results they waited until Thanksgiving weekend to call me on the phone and tell me I was positive and had cirrhosis.
The doctor hung up after delivering the news telling me to "Have a nice weekend!" Yeah...that was about the furthest from the truth it could get. There is good doctors and bad doctors. Compassionate ones and some that seem to not have a grain of humanity whatsoever. You have to pick and choose. If you go to one and you don't like their attitude or the way the treat you, move on. That's the best advice that I can give to anyone. It's how I find the best doctors, and happy to say, all of mine are human now..completely.
4. fliste - May 11 11:19am
I completely agree with Josi. Also, this article isn't very helpful. Most doctors are not going to read a long list of questions ahead of the appointment... In fact, if you sent it to them they would probably refer you to a psychiatrist for your "excessive worrying and over-planning".
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