TEALE FENNING

Nick Raine-Fenning · Posted: Thu Nov 09, 2006 2:50 pm Post subject: Am I going to die?

You have just told a woman she has cervical cancer following a punch biopsy. She obviously needs staging but asks you straight off ...

Quote:

Am I going to die?

m.karoshi · Joined: 24 Oct 2006 Posts: 11

Please don't think in that way. Together we will work out the best for you. I know you are concerned and I am really worried about you and I will help you to overcome this.

Nick Raine-Fenning · Posted: Fri Nov 10, 2006 8:41 am Post subject:

Good effort Smile

I would suggest dropping the 'I am really worried about you' in this instance as this is more appropriate for benign disease and under these circumstances may be misinterpreted as 'bad news' or 'spread'.

You could also try 'Why do you ask that?' or 'I do not want you to think like that'.

Anymore suggestions?
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

bronwyn · Posted: Fri Nov 10, 2006 10:28 am Post subject:

How about
"That's not something we should be thinking about right now. What's important is that we do the necessary investigations to determine the best treatment we can offer you to treat your cancer appropriately. I understand that this has come as a huge shock and that you are scared but we're going to get through this together"

Smile

BB
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Bronwyn Bell
SpR
Portsmouth

Nick Raine-Fenning · Posted: Fri Nov 10, 2006 12:45 pm Post subject:

Like it.

Not sure about the 'thinking about right now' bit as you are almost implying it will become necessary to think about it and hopefully it will not!

I would also recommend that you refer to treating 'her' and not her 'cancer'.

Also never forget you do not 'understand' anything!! Better to say that you cannot understand how she feels but you can only imagine this has been an obvious shock.

Nick Raine-Fenning · Posted: Fri Nov 10, 2006 12:50 pm Post subject:

I suggested on the recent Circuits Courses that the only time you tell someone they are going to die is when they are "Cheyne stoking" defined as ...

Srin · Joined: 06 Nov 2006 Posts: 5 Location: Nottingham

What if they suddenly get aggressive and say something like "Dont you tell me how to think!!!)
It could all go pear shaped!! Shocked

Nick Raine-Fenning · Posted: Sat Nov 11, 2006 9:44 am Post subject:

I doubt that.

Remember this is not the real world! They will not be primed to get angry. Marks will be deducted however for saying some of the comments I mention above.

I asked my wife last night what she would want to be told and she said she would want survival rates. I guess everyone is different. I just do not feel it is helpful at all to tell someone they are going to die or that they may die especially when many do not!

It is a difficult scenario. Be considerate and make sure the patient knows you are there for them. It does help if you know what you are talking about though Wink

Abik · Posted: Mon Apr 02, 2007 6:08 pm Post subject:

Tricky tricky!

It's good to back in business on the forum!
I hope we all get back into our usual routine!!

This one is hard.
I think that I would say;

' You will need treatment for the cancer and the aim of that treatment will be to cure you.
PAUSE The first thing we need to know is what treatment is going to be most effective in you and in order to do that we need to perform another operation to look closely at your cervix, bladder and bowel. From this we can plan the treatment which may involve a hysterectomy or radiotherapy or sometimes a combination of the two.'

Nick Raine-Fenning · Posted: Tue Apr 03, 2007 11:08 am Post subject:

absolutely - cervix is a tricky one that's for sure and you need to know when radiotherapy is all that can be given and when a tracehelectomy may be appropriate - annoying but true.
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

faryal33 · Joined: 15 Feb 2007 Posts: 22

hi nick.I passed my theory.I need some help for the osce since i canot attend any course at the moment.
I think i wll say that"

Im sorrry that you feel that way.i know i Cannot feel how u feel rite now but i want u to knwo that i am here to help you.Lets take one day at a time and then take it forward. In order to plan our treatment ,we need to do a thorough examination under anasethesia to loook at yr cervix,bowel and bladder closely to decide what is best method of treatment for you.It may be removal of the womb with ovaries and tubes or u may need radiotherapy and chemotherapy and forego surgery.Please understand that we all pass thru some difficult moments in our lives and we have to deal with them one way or the other.Im here to help you and i will try my best to make things come out the best for you.

Nick Raine-Fenning · Posted: Tue Apr 03, 2007 12:07 pm Post subject: Re: hi nick

Hi and well done

Overall pretty good but best avoid phrases like ...

Abik · Posted: Tue Apr 03, 2007 1:39 pm Post subject:

Congrats Faryal33!!

These scenerios are great and vey thought-provoking.
I think that with someone we have just met we should avoid trying to be anything more than their doctor who is only going to plan their therapy and in a lot of cases hand them straight over to an oncologist.

I think we should avoid phrases like 'we will get through this' or 'I will help you get through this' or 'I will do my best'

This woman is asking - 'what will happen next? is there treatment and will it help?'

Nick Raine-Fenning · Posted: Tue Apr 03, 2007 4:41 pm Post subject:

You may be right but I quite like the 'we' bit as 'we' can mean the team, the NHS, etc
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

Abik · Posted: Wed Apr 04, 2007 11:20 am Post subject:

No, I agree - 'we will do this operation and we will find the right treatment' is great.
I'm not a fan of the expressions that imply that you (the doctor) are going to go through this with the patient - you are not.

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

Hi everyone! I'm so glad I'm back in action! Nick, the south coast is coming to the circuits I on the 23rd and 24th (I think) but until then, what kind of preparation you suggest? I'm a bit lost, plus that I'm feeling that I've forgotten everything!!

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

P.S. Congratulations to everybody!

Nick Raine-Fenning · Posted: Wed Apr 04, 2007 3:55 pm Post subject:

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

I can definitely tell you how much I have improved my practice through all this studying and the preparation for the exams and surely your course helped me a lot. And I think that this is the greatest benefit of these exams. I really look forward to meeting again on the course!