I've been having a conversation about whether it's appropriate to give a bad news diagnosis over the phone.


The "rule" around here is, give good diagnoses over the phone, but people should be called into the office for a bad news diagnosis.


I find that confusing.  "I can't give you the diagnosis, we need to discuss it in person" means, there's something bad but you can't discuss on the phone.


On the other hand, telling people over the phone could mean they are driving, or at work, or other place where it might not be a good setting.


My cancer diagnosis was in the Emergency Department, because it resulted from a pain crisis and that's where the scan was done.  The doctor who delivered the news was such an asshole, I would as rather have read it as a text message.  Actually that would have been better.


I think it's very situational.  Sometimes you can negotiate with people - do they want to make an appointment, take off from work, pay a copay, and come in for what you hope is a good result?  Do they want the bad result  over the phone?  What about email - I don't think that's a good idea, but a lot of people demand results and even treatment by email now. How bad should the news be to prompt calling them in - new onset diabetes? Need a cholesterol pill? Metastatic pancreatic cancer?


So I wonder what people think.



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I had my yearly mammogram, a few days later my primary physician called and said simply, "Joan, it is cancer." My response on the phone, and I am sure would have been the same if she had called me into her office, was, "OK What is the next step?" or something to that effect. A whole string of appointments started with a Surgical Oncologist and Breast Surgeon, Medical Oncologist and Hematologist, Radiation Oncologist, oncology dietitian, and an oncology psychotherapist. They spelled out options for me and helped me make decisions based on the best evidence they had. I was able to do some research on my own and came up with plans that held the highest probability of getting all cancer cells out of my body. 

For me, a simple phone call is all I needed or wanted. Especially after all the other oncologists who were involved. My past 10 months have been full with consultations, treatments, and monitoring. 

An email message would not be adequate for me. Too impersonal, too mechanical. The phone call was a very personal one, with full attention to my reaction. I am not sure my primary doctor would call everyone with the news; she knows me well enough to trust me to be able to handle it. I know fully well not everyone has my resilience, even with such news. Life presents us challenges and my task is to be flexible and adaptable. 

I think there is the key in Joan's post: personal, with full attention to the patient's reaction. But not every medic is able to tell news in that manner.

A thoughtful phone call seems best to me too.   Especially, if you are called in for follow up of the mammogram, that's all but the same as telling you a cancer was found, or a suspicious finding, but without making a plan at that moment.  Leading to more stress and delay of treatment.

Considering how much bad new there is, knowing how best to deliver it is important.

That's a tough decision.   Glad I don't have to make it.

Personally, I prefer to get a phone call, telling me immediately what's up.  Asking me to come in to the office gives me a long time to worry.  Not good.  Even an e-mail would be preferable.

Now, what about another option?  What ever happened to house-calls?

Insurance system and govt. calls the shots.  5 patients, maybe more, can be seen in clinic in the time it takes to make a house call.  They do have home health, which medicare covers for specific situations, and only for home-bound patients.

OK, I guess that answers that query.  Figured it would be something like that.  Thanks.



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