Two conversations

“Nice to see you, Joe, how are you feeling?”

“I’m fine, doc. We had a great holiday.”

“That’s great. You look fine. I am glad you had a good time.”

“How was your holiday, doc?”

“Good, good. The kids were over, it was a lot of fun. My wife cooked. She doesn’t usually cook, so that was an event itself.  It was fun having the kids over.”

“That’s good doc, that’s good.”

“I see you lost a little weight.  That’s not easy, especially this time of year.”

“Thanks, I’ve been trying to get some exercise.”

“Yup, exercise is good.  Bring down your cholesterol.  Good for your heart.  It keeps your blood pressure under control.  Me, I bought a rowing machine. Strengthens the muscles, joints and bones.”

“That’s great.”

“So, Joe, I was thinking. Well, I was going over your blood tests. They look pretty good. Your liver and kidneys and nutrition are great.”

“That’s good news.”

“Well, I have just one concern. Just a question really.  Nothing for sure. Nothing urgent.”

“What’s that?”

“Your blood count has changed.  Not a lot.  Just a little. It might be nothing at all.  Perhaps it is a lab error.  We need to do a repeat blood test.  Maybe a couple of other labs.  Just check things out.”

“Sure, doc, whatever you want.  More blood tests, today?”

“Yup, let’s draw some blood today.  Why don’t you come back on Friday and we’ll see if there is anything else we need to do.”

“OK, thanks for seeing me.  You’re a great doctor and I really appreciate your help.”

*   *   *   *   *   *   *   *   *   *   *   *   *

“Nice to see you, Joe, how are you feeling?”

I wonder if he saw the blood test results?

 

“I’m fine, doc. We had a great holiday.”

“How am I feeling?” Shit, something is wrong.  He usually asks first about my family. Could it be my lab tests?

 

“That’s great. You look fine. I am glad you had a good time.”

He has no idea.  It would have been easier if he had a clue. Why don’t patients check their labs online?

 

“How was your holiday, doc?”

He knows something… delaying; staring at that damn screen.

 

“Good, good. The kids were over, it was a lot of fun. My wife cooked. She doesn’t usually cook, so that was an event itself.  It was fun having the kids over.”

I will have to tell him something; start slow, a warning shot.”

 

“That’s good doc, that’s good.”

It must be bad.

 

“I see you lost a little weight.  That’s not easy, especially this time of year.”

That’s it. Start slow. Hint.

 

“Thanks, I’ve been trying to get some exercise.”

My weight?  2 damn pounds? This is not good at all.

 

“Yup, exercise is good.  Bring down your cholesterol.  Good for your heart.  It keeps your blood pressure under control.  Me, I bought a rowing machine. Strengthens the muscles, joints and bones.”

If I keep delaying much longer, he is going to get suspicious.

 

“That’s great.”

Oh, fuck, it must be really bad.  He can’t even look at me.

 

So, Joe, I was thinking. Well, I was going over your blood tests. They look pretty good. Your liver and kidneys and nutrition are great.”

Give him a chance to focus. Don’t want to surprise him.

 

“That’s good news.”

Was that a warning shot?

 

“Well, I have just one concern. Just a question really. Nothing for sure. Nothing urgent.”

That’s it; tell him we need more tests.  Confirm.  Check things out.  No reason to hit him with the whole thing at once.

 

“What’s that?”

A concern?  A question? What does that mean?  How sick is a concern?

 

“Your blood count has changed.  Not a lot.  Just a little. It might be nothing at all.  Perhaps it is a lab error.  We need to do a repeat blood test.  Maybe a couple of other labs.  Just check things out.”

That’s it, be gentle. Vague. Baby steps.

 

“Sure, doc, whatever you want.  More blood tests, today?”

He’s trying to protect me.  I must be in big trouble.  I wonder if there is any hope? Did he already give up?

 

“Yup, let’s draw some blood today.  Why don’t you come back on Friday and we’ll see if there is anything else we need to do.”

That’s your clue.  Stand up. Walk to the door. Excellent.  Quicker than I thought. No hard questions. Gave him a chance to cope. Maybe he’ll bring his wife with him for the next visit. That would be easier.

 

“OK, thanks for seeing me.  You’re a great doctor and I really appreciate your help.”

Come back in 3 days?  Could it be cancer?  It must be cancer.  It must be cancer. Cancer.  Stage 4 cancer. I wonder if I’m going to die?

 

 

7 Comments

  • Paula Kaplan-Reiss
    That's it? That was terrifying? Was he right? Was it nothing? I get it. The patient always worries what the doctor isn't saying. Should we be?
  • Hmmm...I wasn't thinking of the worst while reading it but I am now! Blood work again?
  • A year after surgery, the patient is still at the breast center 3 1/2 hours after arriving. No one has told her why she's kept there. . . I could have used a little conversation!
  • Penny egan
    I enter the waiting room with my husband, rare eye contact with seated patients ... They flip through worn periodicals, I say hello ... I wonder shall I try to make conversation with someone, anyone... Is everyone more comfortable being left to their own thoughts and fears... I wish to help...but I'm not a patient... I'm the care giver lost in it all.....
  • D Someya Reed
    As a patient, why bother going to the doctor if you're afraid to voice your concerns about anything spoken or not? As a doctor, why bother being one if you're afraid to talk to your patients and would rather hope they'll figure things out on their own? This reduces the "conversation" to that of the random store clerk who asks if you have any exciting plans for the weekend having already asked the same of everyone ahead of you and will be asking it again of everyone behind you. Do you really think every unknown clerk really cares about your plans? Or you? Patients in this situation should consider getting another doctor who is "a grown-up" and will level with them even if that means only verbalizing what they are thinking. If patients just can't switch, they should consider bringing an advocate whom they trust and who will ask direct questions when the doctor is evasive. Or...they may as well just stop going to the doctor altogether. What's the point? Patients cause themselves more harm through stress, mistrust and all the things they can imagine MIGHT be wrong with them than almost anything else. Doctors who act this way (as in the verbal/non-verbal conversations above) know they are breaking the "First, do no harm" rule and why. Doctors who act this way need to be "that grown-up" the patient needs and remember that this is what THEY chose to do. It comes with both the good and the bad and they need to deal with it. If they can't, then they are in the wrong profession and need to do everyone a favor and find another job more suitable for their mindset. Why is it so difficult for a doctor to ask a patient something like "I don't mean to worry you but I saw something in your results that have given me some concerns. It may be something. It may be nothing. Now, do you want to know what I am thinking might be going on or would you rather wait until I get some further results in and can be more certain if it's something or it's nothing?" Or maybe be less coy and just state the concerns (but in a kind way). Wow, the Earth did not veer out of its orbit! As to the blood re-tests...far more blood than is needed for testing is drawn to allow for multiple tests (even due to accidental spillage...scary). However, if the first lab in question is so bad that you question their results and you want to use other labs to cross check them then why are you using the first lab at all? Besides, wouldn't this lab have other higher level techs available for re-tests? Is there a suspicion they are sloppy in their procedures? See how easy it is to come to negative conclusions with minimal information? I want my doctor to be a grown-up. I need to be one too.
  • meyati
    I do the jigsaw puzzles. Then I helicopter over my labs, and my scan reports. The first scan report didn't call my tonsil stub. Since then it was called as precancerous or stage one. Me, I went to my ENT, and he removed the tonsil stub, and took biopsies in the suspected areas. Biopsy report:Negative-absolutely normal tissue. The reading radiologist then noted the tissue in the tonsil and adenoid area as suspicious. There other anomalies. Since the reading radiologist(s) never signed the reports, I was trying to figure out if one or more radiologists read the scans. I went directly to the head of the clinic with my questions that included why my head was at the wrong slant-the orders of my oncologist? The order of the company radiologist? No, the tech placed my head at the wrong angle. Great, I get my next scan the 12th. I don't know who will be up on rotation for the reading. I just want the names of the radiologists, so I can understand how they are practicing their art, and properly understand them.
  • Kathleen
    While reading through all this dancing around, I too was wondering when a grownup would step in. Look, some docs could use lessons in kindness, but is this how they learn to function? If evasive pleasantry is part of the job, no wonder my docs insisted that I was fine while I KNEW something was wrong. In this story at least the doc is paying attention enough to recognize the shift. I had to find my own cardiac condition, iatrogenic brain tumor and endocrine damage, and then had to campaign to get them recognized and officially diagnosed. Which they were, all of them, only after years of unnecessary suffering.

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