As tedious as history-taking is for a physician - especially when patients chose to omit a lot of information, is reticent, or deviates from the truth - the most difficult part of a patient-doctor encounter is disclosing diagnosis.
Physicians are trained investigators. While a patient usually comes in with a complaint, it is the doctor’s job to find out the medical condition behind the symptoms. This will entail asking beyond the symptoms’ history.
There is the personal, family, social, sexual, and even gynecologic history that could give a clue as to how and why the patient is experiencing the present symptoms.
This is followed by a physical examination, and results when cross-referenced with the patient’s history may lead to a probable diagnosis.
But sometimes, diseases exhibit similar symptoms so to rule out differential diagnoses, diagnostic tests will come in. These can either be radiologic examinations such as x-ray, ultrasound or MRI, while other cases may require an endoscopy. Cancer patients usually require a biopsy for confirmation.
When all the results are in - diagnostic, endoscopy or biopsy - the final diagnosis is arrived at.
“When we have the final diagnosis, that is when the difficulty comes in,” according to Dr Jimmy Catapia, a surgical oncologist.
Disclosure is the difficult part, he said. Disclosing the diagnosis to patients and their families. This is especially true for a cancer diagnosis, at whatever stage the disease is in.
Dr Catapia admitted disclosure requires a lot of skill as well, one usually not taught in medical school. And even when it is, people are different and will react differently to such devastating news.
Over time, the cancer surgeon has learned that it is usually better to speak to the patient’s family first. “During our meeting, I assess their beliefs and values to have a sense how to eventually break the news to the patient,” he explained.
The specialist usually asks the family how they want him to disclose the diagnosis - “Should I tell the entire diagnosis or just part of it?”
The rule in disclosure is honesty. According to Dr Denky dela Rosa, a cancer specialist from the St Luke’s Medical Center, “it is more compassionate to tell the truth, especially if the condition is irreversible.”
She was further quoted as saying that “the other side of compassion is not to let the family suffer more, I cannot allow my conscience to do that.”
Dr Catapia agrees. Doctors have to be honest with their patients when disclosing their condition. But he has likewise learned to respect the family’s wishes. This is particularly true for patients who ‘shut down’ after hearing the diagnosis, more so if it is cancer, and one at an advanced stage.
Play it by ear, but be professional is the rule of thumb. Even with so many treatment modalities available, with an increasing rate of success, life-threatening diseases for most people still mean facing their mortality, which they may not be ready for. MIMS
Getting their acts together to provide better cancer care
Disclosure of diagnosis: A challenge for doctors
Elma Sandoval, 24 Aug 2017