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Being careful with the ‘C’ word

Am I alone in being horrified by having patients not infrequently arriving at my surgery in a state of shock and distress having been informed by a hospital consultant that they have cancer?

All those years ago when I was introduced to clinical medicine, we were always taught that the word had no place in a doctor's vocabulary, as, when it is used, the patient often switches off to anything else that might be said.

When patients go home from hospital and tell their spouses they have ‘cancer', both parties are often devastated, and come to their GP in a state of fear and trepidation. I well remember one unfortunate man who I had referred to the local dermatology clinic with what I had suspected was a basal cell carcinoma.

I called it a ‘rodent ulcer', explained what its outcome would be both with and without treatment, and the patient was quite happy.

Imagine my horror when the man came back to me some months later having seen the dermatologist and been told he had a ‘kind of skin cancer'.

Out of those four words the patient absorbed only one, and was convinced he had only a very short time to live. It took a long time for me to explain that the condition was as I had earlier described to him, and he would be completely cured – as indeed he was.

There must be a satisfactory way of breaking bad news to a patient without taking away all hope, but I am now at a loss as to what it is.

From Dr Colin Lees,
Airdrie, Scotland

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