‘‘Screw-ups’’ 107
While I was on jury duty, the dermatologist paged me. I remember
his words: ‘‘The biopsy results came back, and they’re not good. It’s
a melanoma.’’ I was standing up in the telephone booth in the
courthouse. I almost collapsed.
In conveying bad prognoses, doctors’ tones may be particularly insen-
sitive. Medical information—even a mere three to five words (e.g., ‘‘you
have cancer’’)—can have terrible and lifelong implications for the in-
dividual patient. Walter, the politically-active internist, was disturbed by
his doctor’s matter-of-factness in presenting the options and the deci-
sion-making process.
He looked at the CT scan and said, ‘‘There’s nothing we can do.’’ I
was devastated. He said, ‘‘You’ll never be able to eat. You have
tumor everywhere. If we get into your abdomen and there’s tumor
everywhere, what do you want us to do? It will hurt, and won’t
change the outcome. You’ll be dead.’’ He didn’t mean it to be
devastating, but it was.
Again, physicians-of-record may be oblivious to the emotional impact of
their words.
Ill doctors also became more aware of the potential insensitivity of
even offhand comments. Jessica, the pediatrician, was upset by what she
perceived to be her oncologist’s sadistic side remarks.
I had two moles on my arms. He said, ‘‘You should have those taken
off before you start radiation. Because a few years from now, if you’re
still around, it could be a problem.’’ I used to cry on the way
home. Because I was a doctor, he would talk to me about his other
patients: ‘‘I have another patient just like you. She looks like you:
same age, and has the same exact tumor. She’s in the hospital.’’ So,
of course I say, ‘‘How’s she doing?’’ He says, ‘‘She’s dying.’’
A physician’s quick remarks may literally be matters of life and death
for a patient, who weighs these comments very differently than the doc-
tor does. Jessica became more aware of casual ‘‘offhand’’ statements by
colleagues in response to bad news.
I told a colleague, ‘‘I have cancer.’’ She said: ‘‘You’re kidding!’’
I found that very offensive. People say that kind of thing and don’t
mean anything—it’s an immediate reaction. But I thought, ‘‘Why
would I kid about that? I’m going to die!’’