Bad News by Phone

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In a new blow to authentic medicine a team of researchers from the University of Michigan concluded that “communicating the news that a biopsy result indicates malignancy by telephone may be better than delivering the news in person”.  Is the whole world going crazy?  Have we sunk to a new low?

Here is the best part.  The researchers said this:

“Telemedicine approaches can potentially relieve much of the anxiety associated with in-person consultations while delivering bad news in a timely, compassionate, and patient-centered manner,” write Naveen Krishnan and colleagues in a viewpoint published in the November issue of JAMA Oncology.

 

Don’t you just love that they used the “patient-centered” term.  It just proves you can use it anywhere you want.  It’s pure Administralian bullshit.  Let me show you:

  • The patient was killed in a patient-centered manner.
  • The doctor was brought to the State Board of Medicine for having sex with a patient but all charges were dropped because he did it in a patient-centered manner.
  • The patient had surgery on the wrong limb but at least it was done in a patient-centered manner.

Do you see what I am saying? That term means nothing!

Listen, this whole study was performed to support the industrialized medicine model of churning people through and treating them like numbers and not people.  What other service industry can get away with such poor manners?  None.

Oh, wait, the government can.

 

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  9 comments for “Bad News by Phone

  1. Catherine
    December 3, 2015 at 9:42 pm

    It looks like I might be the only patient replying. I linked to this post through MedPage Today, and as I am interested in doc-patient communication, felt it might be good to post a patient’s perspective. I had to laugh when I saw the name of the blog because I was just lamenting to a friend yesterday that so many health institution-generated “blogs” are so not authentic.

    I am a freelance writer switching focus to concentrate solely on writing web content, e-newsletters, blogs and patient hand-outs for physicians. I was raised by a pediatrician, and married a medical student, so I appreciate the hard work and dedication it takes to live as a doctor. Now I deal with some chronic health issues (way sooner than I thought I would), so I also get the patient’s mindset.

    I received a malignant melanoma diagnosis over the phone a few years ago. Was I angry with my derm? Oh, hell no.

    The anxiety level while waiting for biopsy results is through the roof. It does not matter how you try to distract yourself – the possibility of cancer is always there. Sometimes it’s yelling at you, and sometimes it’s whispering, but it is Always. There. You are willing the phone to ring. You are not sleeping well at night. You get the idea.

    Now, I’m not sure my dermatologist understood this – he needed me to come in as soon as possible for a (follow-up) punch biopsy, and that’s why he called. Was it ideal to hear it over the phone? Maybe not. But I do know that if his office had called to schedule an appointment to discuss the results, well, I’m no brain surgeon, but I would’ve known that that was not a good sign.

    It’s important for physicians to understand that it does not matter whether it’s by phone or in person because the patient hardly hears anything after you say “…looks like it’s cancer.” We go numb and only think of the gazillion questions we have later. Remember that when you do ask if the patient has any questions. Tell her to call you, or you’ll call her in a few days so she has a chance to breathe and come up with any questions.

    There are advantages to hearing bad news away from the doctor’s office as well. My sister happened to be with me, and her hug was much better than a pat on the shoulder my derm would have given me. If I had been at home, or at work, or at a store, it would have been just as difficult to collect myself as it would have been at the doctor’s office. And, I did know my derm cared – he was reassuring and kind and I heard that loud and clear.

    Now, to Kurt, who had the patient who went off screaming. Dude. You used the word “mass,” which means the same as “cancer” to anyone who did not study medicine. Same with “lesion.” Means “cut” to the rest of the world. If you had started off the phone conversation with “Hey, not sure what it is, but it’s small, and looks like something we can take care of…” or any medicalese-free words along those lines, she would not have had that reaction. And, consider this. If you had called to ask her to come in so you could discuss the results, my bet is that as soon as she hung up she would have gone off screaming “He says he wants me to come in to discuss the results. Oh God I have cancer!!!” Sounds like that’s just the kind of person she was. Of course by the time she presented herself to you at the office she would have had her game face on, and you would never know the extra anxiety you put her through.

    Point is you’re never going to be able to predict a particular patient’s reaction to bad news. Some people are going to want a face-to-face, and that’s not going to matter to others. What matters is what you say and do in the weeks and months after you give the bad news. If you have to give the worst news of all over the phone, follow up with a hand-written note – cathartic for you and appreciated by grieving loved ones.

    Sorry to go on so long. Looking forward to exploring the site…

    • Doug Farrago
      December 4, 2015 at 6:54 am

      Welcome aboard, Catherine. I am so sorry about your diagnosis and I hope they got it in time. The whole point of this blog entry, and site, is to point out how the powers that be are assholes and are trying to “assembly line” medicine. It is just another example of industrialized medicine vs. authentic medicine. In my 20 years of practicing, it is almost ALWAYS better to be face to face with a patient. We are being brainwashed otherwise in order to allow this shitty healthcare model to become accepted and pervasive.

  2. Bill Ameen MD
    December 2, 2015 at 2:57 pm

    Let me first say this: As a family practice veteran from start of training in 1973, I believe “telemedicine” is total unadulterated bullsh*t. No one has defined to my satisfaction what can be safely diagnosed by Skype or phone. If patients seriously have transportation problems in this day and age, then doctors can resume making house calls! In terms of giving people bad news, one of the most difficult moments in my entire career occurred when I was moonlighting in ER and a young woman was brought in with a fatal head injury from a tire that flew off a racecar and hit her while she was walking to the concession stand. I had to break the news to her unseen parents by phone a thousand miles away that their lives would be forever changed. How much I would have given to have been able to hold them and cry with them at that moment. Do NOT give bad news by phone if it’s avoidable, I say…but corporate medicine will say otherwise.

  3. Perry
    December 2, 2015 at 1:11 pm

    I like the idea of texting myself:

    Sorry, u have cancer. ):

  4. Pat
    December 2, 2015 at 11:16 am

    Big Insurance can really run with this: “Yes, we have had to implement some modest premium increases, but they have all been done in a patient-centered manner.”

  5. drhockey
    December 2, 2015 at 10:24 am

    What a great idea!

    I can see the follow up article, to be published Dec. 2016:
    “Using Robots programed for empathy deliver bad news to patients more effectively and efficiently.”

    The 2017 article, “Robots hold the patient’s hand and give them Kleenex via computer when delivering bad news.”

    Okay, turning sarcasm font off now.

  6. Kurt
    December 2, 2015 at 9:20 am

    Stupid, I learned my lessons many years ago when I had this late 50’s woman smoker. This was way before the screening criteria for smokers mind you and I forget what prompted the CT scan. Might have been something on chest x-ray when being being treated for bronchitis .

    Anywho, I get the CT scan (this was in the dark ages mind you) and I was told they had the data but the computer used to process the data choked. Those were the days they let the computer run for hours to get some of the longitudinal views. Told me it would be a couple of days.

    Well, this lady was on the phone seemingly every 30 minutes wanting the results. I and my nurse told her the details surrounding the delay and that we’d be calling her directly as soon as the results came in. She gave us 50 phone numbers to call her to be sure we could reach her when the time came.

    Sure enough after the announced delay, the results showed a small apical mass, I called her at work and told here there is a small spot that we need to have her see the thoracic surgeon so we can find out what it is. Before I could get another word out of my mouth to be reassuring (it was small) she yells, “I got cancer!!!” at the top of her lungs in her
    workplace and goes screaming and bawling out of the room. Everyone
    there thought I was the a-hole Dr. of the world.

    I thought I was doing what she desired as she was on my case to be called
    “right away” . I resolved never to do that again. Good or bad they come back for the results of a serious test. Don’t anyone who reads this make this mistake I made. The ivory tower bastards who come up with this crap should be cast into Gehenna. Kurt

  7. Steve O'
    December 2, 2015 at 9:08 am

    Yes, well… New languages have to be invented by bureaucracies to bring meaningless meaning to things. Orwell nailed it eighty years ago – and Pravda and Izvestiya in the old Soviet Union published reams of sample nonsense for public consumption.
    What is the purpose of publishing nearly-meaningless rubbish? One example of barely-informative nonsense is the “Motivational Interviewing” shtick – a huge cluster of associations built around the realization that talking to a person effectively and genuinely may result in their change.
    Propaganda buzzwords are like Christmas trees – no matter where one stands them, one can drape all manner of things from them for all sorts of reasons.
    Each buzzword is carefully stripped of prior meaning and polished, so that it may adorn one branch and bring its own coded meaning to a topic, good or bad.
    The old Soviet newspapers would never come out and SAY something – to do so seems individualistic and selfish, not the Voice of the People. The message is conveyed by putting a little less glitter and sparkle on one side of the tree, than another.
    “The entire leadership of the Uzkranistanian Secret Police was taken out and shot yesterday. They’ve been ripping off Uzkranistanians with both fists.” Now what an unsettling message!
    Better to say “The People’s electorate has realized the opportunity to expand the inevitable progress of the proletariat in a timely, compassionate, and patient comrade-centered manner by restructuring performance oversight parameters.” Everyone, of course, who reads this stuff can hear the silent echo of the gunshots. But it keeps the truth under control, rather than leaving it out there as some sort of objective entity possessed by nobody.

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