The Hardest Part About Being a GI Doc
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- čas přidán 6. 09. 2024
- Nothing harder than breaking possibly bad news
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Dr you have the heart of a teacher and the compassion of an advocate. Your patients are fortunate to have you.
My dad just went through this with an older GI doc, his way of handling it was to basically say he saw stuff that was concerning and it needed to be checked before a diagnosis could be made, but don't leave it too long, ok? It worked in the sense that he stuck to the facts, there was something and he found it concerning, but he didn't put the c word into my dad's head.
I have a very strong family history of multiple types of cancer, including colon cancer plus a personal history of IBS, so I’ve been getting colonoscopies since I was 20 (I’m now 45). I like the way my GI phrases it to me. “Heather, we took some samples to take an extra close look at. We’ll call in about a week to follow up.
It conveys the message that they found some areas that need a little more attention, but doesn’t cause panic or excessive anxiety. It also gives me a time frame to expect a follow up call so I’m not waiting anxiously by the phone.
A friend just got through his third "this could be cancerous" diagnosis (all three were benign). I can only imagine how hard this sort of thing is, from your point of view, but thank you for doing it all the same.
If I were in your friend's shoes, I'd probably tell the doctor (assuming all three were in his GI tract) "well, seeing as the past two masses in my colon were all benign, either there's something else going on or your cancer testing procedures are f*cked.
@@moonman239No, they have been scattered.
Doc, a word of advice from a patient. We are not in the best mental state after a procedure. I would just say something like " we found a mass/polyp, I've taken a biopsy and am sending it to the lab to see whether there's anything to be concerned about." Don't mention the word cancer, even if it's not, we are going to be anticipating the worst from then on. If it is cancer, and you are called in for your consultation with the doctor (hopefully poor results are not given over the phone), one is slightly more mentally prepared.
When a rookie vet mentioned that my rescue pup might have lymphoma because of enlarged lymph nodes, I balled my eyes out until the results came back, not cancer but an autoimmune condition. But everytime after that, whenever his lymph nodes got bigger, my first panicked reaction was that it was cancer. 13 years later, he's still with us, but I don't forget the shock of that first appointment, and still have flashbacks.
Agreed - having been a GI patient, it's not a big deal to hear there's a polyp, and it's pretty straightforward to understand you don't know what it is until you get the biopsy results. On the other hand, it would be nice if we could have a little time to recover from the anesthesia meds - I have yet to have a colonoscopy where I remember what my doctor said to me afterwards. Good thing I get written notes, but still.
Maybe something like “I found something that looked concerning so I took a sample to be tested in the next week”
Which lymph nodes are we talking here?
@@mattsainsbut patient won't stop with that answer
They ask what and why there is a concern!?
The thing is, your preference is not the preference of every patient. There is no way to know the preference of every patient. There is only the option of being as truthful as possible while conveying a sense of compassion and gravity. We can’t risk the patient misunderstanding, so clear communication is more important than what to avoid saying as to spare the patient’s possible feelings. There is often no predicting what those may be.
Doc Schmidt, you have such a big heart. ❤ I think that beforehand, it's important to reiterate that if there are any potentially cancerous polyps, they will take a week to be confirmed or denied and just let your patients know you're there for them in the meantime to answer any questions that you can.
And the real problem about the post procedure report to the patient is that the patient is still under enough anesthesia they have no clue what you are talking about, at least no recollection, other than you may have stopped by and said something. No paperwork to document what was actually said.
As a Crohn’s patient who recently had a colonoscopy where everything was as expected (you know, not “normal”, but no worse than before)…it was SUPER WEIRD having the doctor telling me about it as I was still pretty woozy from anesthesia and in the stupid gown on a rolly bed. Honestly, just telling me up front that results would come after the fact and getting a phone call a week later would have made way more sense.
I’ve got UC and my gastroenterologist is an absolute sweetheart. And he got my guts calmed down first try!
My first gastroenterologist wanted to stick me on steroids forever because Mesalamine made me bleed and he chose not to believe me.
I hope you still have this much insight and compassion, 15-20 years from now. The healthcare and insurance industries tend to make good doctors mediocre and cynical.
I think you should explain it to the patient in the way you have in this video. That you don't want to "decimate their hopes" or "give them false hope".
Being open and honest is always a good policy. I'm sure the patient will leave frustrated, but I imagine you're just as frustrated and sometimes that's okay to express to them.
It's important that your patient trusts you and feels like you've given them all of the information and the best information available.
If they leave the office thinking that you're hiding something or that you're looking down upon them, then regardless of the pathology results, they will always be questioning second guessing you and that can lead to resentment or worse disobeying orders.
I can tell you from experience that even if you had a definitive answer. That telling patients anything in that post anesthesia haze isn't that useful. It would be better to talk about some of the what if's during the pre appointment.
As someone who went through cancer 2 years ago, I can tell you that waiting period is the hardest part. Once you know for sure and have a plan in place, somehow your mind eases just a little. My issue with the doctors is they give you that appointment 2 weeks out from a biopsy, or a surgery, or a scan. Most times they know much earlier. I realize they’re busy with many patients, but I don’t think that they’re thinking of the emotional toll this is taking on you. They are living life, while you’re passing those days thinking the worst, and crying, and having headaches, and sick to your stomach from worry, and not sleeping. If my primary doctor orders a scan, he lets me know the results either that evening or the next day. I never even realized scan results are sent to them so quickly. If it was another doctor, they would say 2 weeks because you’re a protocol, not a patient who is upset with worry. Just my experience.
Thank you for this. I'm 45, amd just got a post card in the mail from my hospital where my PCP works for my first routine in home colon cancer screening (the joys of aging!). This really gives me insight into just how difficult it is for doctors talking to us about the results (even if my procedure is different). Needless to say, it's nervewracking, because while I doubt I have cancer, there's always that "what if I do?" that plays in the back of my head. This helps me see things from the doctor's perspective, and really helps me to have compassion for you guys, which makes the situation somehow easier, because it reminds me that you're struggling with all of this, too, because you're going through the fear of the unknown with us. You have a really good heart for showing as much care and empathy as you do. Thank you for everything you do. ❤
ngl if someone tells me they found a mass in my colon I'm gonna expect a poop joke.
Thank you for finding the humor in a truly terrifying situation that I thought was utterly void of humor. You truly are a rare soul for being able to do so! 💖
"yeah sorry that was yesterday's tacos, they stick around"
Best one I've had, they just said:
"I'm not sure about the look of this, need to take a piece of it to find out more. Don't worry, I'm coding it as required and/or preventative for your insurance. I'll call you in a few days."
While they never called, I gave in and did after 2 weeks, I also wasn't sitting in terror waiting for the phone to ring. Or worrying about the bill.
"we found a mass that requires further evaluation" is what my GI doc went with, it works well in my opinion.
That is a tough situation to be in Dr.
And you're talking with them while they are still under the effects of the drugs administered earlier. Not too good. Best to write it all down, too. I was with a friend as she was awakening. Her surgeon (colon and rectal) came in to say that she had a new, large sessile polyp that was likely to be malignant. That was upsetting to us both. About 10 min. later, he returned to say, "Sorry. I confused you with another pt. Your colonoscopy was normal." Well, could have been worse....hemicolectomy on the wrong pt. Wrong segment of colon removed on the right pt., etc., etc.
Now you can send them this video.
My 22 year old son with UC and PSC was barely conscious after his colonoscopy when the GI doc came in and said that in his 20 years of practicing every single time he has encountered a lesion that looked like the one he found in my son- it was cancer. He said it looked visually like textbook cancer,but not to worry. Just wait until pathology came back. Incredibly it was benign. This UC & PSC since he was 14 has been an emotional roller coaster.
I am terrified of wasting $15,000 just to get tested when I know that my health insurance will not cover it.
Talk with your doc. At least consider Cologuard.
USA! USA! USA!
All joking aside, are you sure your insurance won't cover a screening? You may want to dig into this a bit, because if it's a screening just based on age or risk factors it may be covered at 100% as a patient well visit. Just do a bit of work to check. Would you rather owe a little money, or be dead? (Also, if money is tight hospitals will lower your bill drastically, or forgive it completely). Good luck, friend 😊
I thought it was a law, it's preventative
C diff nearly killed me. I spend a month in the hospital and had 2 unsuccessful fecal transplants.
As a patient ( and a nurse ) in the U.K. it’s the waking up bit that surprises me. We’re really encouraged to take no sedation as it means they can discharge us after literally 10 minutes. Usually we get a letter handed to us with the results and sent on our merry way. I had to google some of my letter as I’m not a GI expert - I’ve yet to have any explanation or advice. Generally it’s not good to speak to patients who’ve had a general anaesthetic or sedation, they rarely remember any of it.
The NHS has had all the humanity stripped out of it by defunding sadly - over in France they do sedate lightly, it reduces discomfort and such but also leaves people pretty alert after just a short recovery.
Here in the States colonoscopies are mostly done using propofol and people are pretty with it quite quickly afterwards. I'm a nurse and have also had colonoscopies. I remember everything I was told by the GI doc afterwards.
I've also had multiple surgeries with full general intubation anesthesia and it's pretty difficult to remember stuff you're told in recovery after that.
@@margaretbear I think that’s why we get letters - people are nervous and don’t remember everything said by a doctor. Especially if you have no medical background. I’d much prefer some sort of sedation, though at least you get to drive home without it.
I have the same problem in urology when I'm seeing patients for an elevated PSA. At the stage they're seeing me (a PA), I'm telling them they need to schedule a prostate biopsy, then see the doctor in two weeks for the results. They always have tons of questions about treatment, and I have to emphasize that it's all hypothetical at this point.
Ive just been through this scenario in the last 6 months. Two scopes and two surgeries. I depend on the pathology reports to lead decisions. The last report was the best which said the cancer had not spread to lymph nodes and i don't need further treatment. It all started with a positive FITest that is routine screening in Canada
I hear that. OB goes through the same thing with their patients who have consistent abnormal pap's.
Oh I thought you were gonna say the hardest part is getting Xifaxan covered
😅
U wake up ( barely awake from anesthesia) they tell u dont make important decisions or work that day- but they do tell u - u may have cancer- now sign your d/c papers and next pt plz !!!!
I think a colonoscopy is in my near future. I have a lot of painful symptoms and my gynocologist found free fluid in my abdomen and they haven't found out why, still searching. But I'm really scared of the prep stuff to drink. Once I had to drink it to "help" my intestine. But other than that I got extremely nauseas it did absolutely nothing. So I'm worried how to do a colonoscopy if that prep don't even work because my colon is so not functioning properly.
Oh, you were serious. I figured the hardest part was dealing with all the patients crap. But now i kinda feel bad about the joke.
Seriously though, that's got to be tough on everyone, and there isn't going to be any one good answer. Everyone will need something different. But I'm sure the fact that you care will go a long way. Good luck.
I certainly understand. As a ns midwife I had to give terrible news. It never got any easier.
I was so drugged after my last colonespy, I have no clue if anyone talked to me. I just remember getting into the car with my husband.
And that's a major issue when a doc. wants to talk with you immediately after a procedure. You should ask for his comments in writing.
Waiting a week sounds like a blessing. I normally have to wait 1 month+ to know the results
Why can't it be sent and looked at somewhere in the facility so they can have those answers before they leave?
There usually is a pathology dept. in bigger hospitals, but they do this for every department so there's always many samples waiting, and also they have to treat the samples with different chemicals to get the reactions/coloration they need to diagnose it, and that takes time.
3.5 years is a long time in most roles. I understand medicine is different but in college 10 years ago I was thought if you have been in a job 2 years you should have mastered 90% of it and be ready to move on.
Just a guess, but I'm thinking you're a white collar worker?
No other industry I've been in has that. Fairly recently, I moved to white collar work, and those several tiers above me (and not our LOB) have the "3-years & move on" mindset.
I just find it to be such a different way of thinking about progress and/or success.
Please tell me that you don't let biopsy results get sent through Epic or the like. Because do I have my own story of something that was suspected NOT to be cancer (found during an ultrasound to figure out why my period was nuts). It got biopsied under ultrasound, and the results of it being a GIST came to me on the computer. When I had an appointment with the doctor later that week.
After the egd and colonoscopy took over and hour and a half, I was brought straight back to my husband (33 years old) who was just waking up. We were then whisked to a side room while the GI Dr finished the procedure after my husband’s. “We found a mass and it is almost certainly cancer.” Slapped him right out of any remaining propofol stupor.
Everyone involved in the care of other human beings absolutely needs qualified peer support
And that's why the SPIKES model is your friend in this case
What's the SPIKES model?
@@crow_feather It’s a structured way to break bad news to patients or their friends/family/relatives:
S - Setting: quiet and isolated room, ensure no interruptions
P - Perception: ask how much they already know
I - Invitation: offer to deliver the news then and there
K - Knowledge: deliver the news
E - Emotion/Empathy: demonstrate empathy and respect the listener’s emotions, such as remain quiet and let them cry if they need
S - Summary/Solution/Strategy: come up with a plan before the end of the consult
Do you do upper endoscopies ever?
Doctors generally just say, we did biopsies to check around. We are waiting on the results. I think he's over playing it here.
I think that would be very inappropriate for a doctor to say if he was highly suspicious for a cancer. Very misleading