Agraphia Medical Tragicomedy


Being Reticent

I've been thinking about the practice of hiding information from patients (thanks to one of the comments in this post). In the link above, "hiding" information is looked at as a bad thing... lets come back to that idea in a moment.

To give a few examples:

12 year old child presents with new-onset seizures and a focal neurologic deficit.
65 year old man presents with recent lower back pain and difficulty urinating.
54 year old woman presents with difficulty swallowing and extreme emotional lability (laughing and crying within seconds of each other).

Each of these examples in a physician's mind immediately raises the specter of a wholly unsavory diagnosis. The 12 year old probably has a brain tumor, the man has metastatic prostate cancer, and the woman has pseudobulbar variant ALS (Lou Gehrig's disease). These are all really, really bad things to have.

What if I told you that the kid only had meningitis, the man just BPH and a pulled muscle, and the woman had a harmless psychiatric condition called conversion disorder†? Would it really be a good thing if I walked in the room and made a spot diagnosis without all the information? For the 45 minutes it takes to get the CT scan, the parents of that kid think their child is going to die. I certainly don't want to be the person who does that to them.

All I'm really saying is that we aren't doing it to hide information from you... we're just trying to avoid giving bad news unless it's due.

† I'm stretching that last one... unfortunately, she very likely has ALS.

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  1. Oh dear lord, you’re reminding me that I remember nothing about the brain.

  2. I realize the world is full of stupid people – really it is. But as a doctor to a patient just tell me what you think. I would much rather have you spill every possibility than leave me wondering what you might be thinking.

    I love this blog. I have had two really good doctors in my life. One is my Internist who was/is very thorough and talked to me like I had intelligence and unfortunately I have not seen him in 5 years because he no longer accpets my crappy insurance. The other is my GYN who also talks to me like I have some degree of intelligence. I will forever be devoted to both for this reason alone.

  3. There was article on NPR last week about medical blogs. It reminded me of you and yours:

  4. There’s a good reason why we don’t tell patients bad news unless we’re absolutely sure. Just last week I had a patient with a three month history of dysphasia/odynophasia, able only to eat liquids, 40 lb weight loss, severe vomiting, hgb of 4 on admission, CT scan said “malignancy cannot be excluded” about 4 times, everything pointing toward cancer…turned out to just be severe esophagitis. My resident and I thanked our lucky stars we didn’t say the patient had cancer until we were absolutely sure.

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