What I Learn From Breaking Bad News to Patient

Yesterday morning, I took my first full medical history from a real patient. With anxious, I never would have expecting my first experience would be a quiet emotional one. One that will never be forgotten. After introducing myself and asking for his consent, we begin the interview.

Me: First of all may I know your name?
Patient: A.T. (for sake of patient’s privacy, I don’t write the name).
Me: Can I call you Andrew?
Patient: Yes. Of course (with smile on his face).
Me: Okay Andrew. Can I know your date of birth please?
Patient: 17th September 1956. Do you know what day is that?
Me: Hrmm..I don’t really know. Is that a big celebration day in Ireland? Or is your favourite sports team win a cup on that day?
Patient: Haha…looks like you cannot ask the other questions until you answer that (while laughing)
Me: Erkk… (I don’t really know what date is that!)
Patient: James, you know what day is 17th September? (James is the other patient whose bed is besides Andrew’s)
James: (he had to think deep first before laughing with Andrew) Haha, you can’t ask anymore until you know what day is 17th September!
Me: Err… (is’t that important!!)
Patient: Nurse, can you guess what day is 17th September? This guy ask my date of birth (he asked the nurse who’s checking some file while referring the guy to me)
Nurse: 17th September? Hrm… it’s the date today…Oh, Happy Birthday Andrew!!
Me: Oh yeah. Happy Birthday Andrew! I forgot the date today..haha

The whole ward who heard our conversation laugh.
…………
After I finished asking about his presenting complaint (he actually had a needle-like chest pain but for 2 consecutive days), before I could ask about his past medical history, suddenly a group of consultant, nurses and students come to Andrew while closing the curtain. I was like,,, what happen now? Is there any fire drill or anything?

Consultan: Hi Andrew, my name is Dr. Barry. I’m a gastroenterologist surgeon. How are you today Andrew?
Andrew: Yes I’m great. (the smile on his face is still there)
Consultant: As you may know, we already told you that we found a dark mass in your right lower flank. After investigation, we confirmed that it’s actually a cancer.
Andrew: Alright. (he’s whole face turn red. I can see that his eyes crying)
Consultant: But the good news is that, it doesn’t spread anywhere, it’s just local. So, you should be fine after we remove it though surgery. Would that be okay?
Andrew: Yes, I’m alright. I’ll try to keep a positive mind.
Me: (Oh no…why must he tell him today. On his birthday!)

After his conversation with the doctor has finished, I planned to stop taking his history since he just received that huge life death news. Even his smile cannot cover the shock and sadness. But he keep insisting that I continue it. Rather than pushing him, I continue but try not to talk about the cancer that he’s having.

This is a good lesson for me. There will be times in the future that I, as a doctor would break the bad news to the patient. But even a little, I’ll keep a reminder to myself to check the patient’s birthday/mood before anything.

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