Delivering Bad News —Medical Privacy

Show notes & transcript

Delivering Bad News — Medical Privacy During a Cancer Diagnosis

Scene: A private room in a family medicine clinic. A 56-year-old patient, Mr. Wilson, has returned to discuss biopsy results following a colonoscopy. The doctor has reviewed the report, arranged uninterrupted time, and sits at eye level.

Doctor: Mr. Wilson, before we discuss your results, would you like someone you trust to join us, either here or by phone?

Patient: My wife is outside, but I would rather hear the results myself first.

Doctor: Of course. We can invite her later if you want. What have you understood about the tests so far?

Patient: They found something in my bowel and took a sample. I was hoping it was just a polyp.

Doctor: Yes, they took a small tissue sample to find out what the growth was. Would you like me to explain the result now?

Patient: Yes. Please tell me directly.

Doctor: I’m afraid the result is more serious than we had hoped.

The doctor pauses briefly.

Doctor: The biopsy shows cancer in your colon.

The doctor stops speaking and allows silence.

Patient: Cancer?

Doctor: Yes. I’m sorry to have to give you this news.

Patient: I wasn’t expecting that. I feel fine most of the time.

Doctor: This has come as a shock.

The patient looks down. The doctor remains quiet and offers tissues without rushing.

Patient: Does this mean I’m going to die?

Doctor: I hear how frightening that question is. The biopsy tells us that this is cancer, but it does not tell us how far it has spread. We need more information before we can discuss your outlook accurately.

Patient: So you don’t know how bad it is yet?

Doctor: That’s right. I don’t want to give you an answer that the results cannot support. We will arrange the next assessment and a specialist consultation to understand what treatment may help.

Patient: I keep thinking about my children. My youngest is still in school.

Doctor: Your children are your biggest concern right now. What worries you most about telling them?

Patient: That they’ll think I’m dying. I don’t even know what to say.

Doctor: You don’t have to explain everything today. We can help you decide what to say once you have had some time to take this in.

Patient: I think I need my wife here now.

Doctor: Would you like me to invite her in and explain the biopsy result and what we know so far?

Patient: Yes, please.

With the patient’s permission, the doctor arranges for his wife to join them.

Doctor: Before we bring her in, would you prefer to discuss the next steps now, or take a few minutes first?

Patient: Just tell me the basics. I can’t take in much more.

Doctor: Of course. The next step is further assessment to establish the extent of the cancer and a referral to the specialist team. They will discuss treatment options with you. You do not need to make a treatment decision today.

Patient: Will I still see you?

Doctor: Yes. I will remain involved in your care. We will arrange a follow-up, and my clinic will help track the referrals and outstanding tests.

Patient: I’m worried I’ll forget everything you’ve said.

Doctor: I’ll write down the main points and the plan. We can go over them again with your wife, with your permission.

Patient: Thank you.

Doctor: I’ve given you difficult news. To check that I explained it clearly, could you tell me what you understand so far?

Patient: The biopsy confirmed cancer in my colon. You don’t know whether it has spread yet. I need more tests and to see the specialist.

Doctor: That’s correct. What is the most important question you still have right now?

Patient: How am I supposed to get through today?

Doctor: Let’s focus on that first. We can bring your wife in, give you both some time, and talk about the support you need before you leave. Would you like us to help connect you with counselling or another support person?

Patient: Maybe counselling. But first, I just want my wife.

Doctor: Of course. We’ll start there.