Tuesday, November 20, 2012

Something for you to think about...

To make up for my last short post - I'll give you guys something to think/reflect about.

So you meet a 55 year old male patient on the  neurology ward who was admitted with severe unilateral headaches in the front which radiates to the back of the head with no associated neck stiffness. As you talk to the patient you notice he's fairly relaxed and quite talkative. He tells you how he first presented to his GP 4 weeks ago who didn't explain much and sent him for a CT/MRI scan on his head, then proceeded to send him for Chest X-rays...eventually getting a pelvic MRI scan. The patient says: "I have no idea why I had to go through all these scans. Bit pointless in my opinion. It's just a headache...any ideas doc?" You know all these events had happened over the last 4 weeks and this patient has seen several doctors and you start to wonder why no one has told this man why all these investigations were done. Eventually you find out that the patient is aware that there is a "lump" in the back of his brain and that he's being scheduled to get a biopsy. After saying this, the patient still seems very relaxed and seemingly unaware of what is going on...actually he ends up telling you that he actually doesn't have a clue what's going on.

After the nice conversation you've had with the patient, you go look in his medical notes. You read the report from the scans which clearly says: "Query metastasis to the brain". You know that the GP/other doctors had sent this patient for several different investigations is to locate the primary cancer - which the patient is completely unaware of. Next imaging report: "Primary glioma". All brain tumours are technically malignant. Then you think: does this patient know he's possibly got brain cancer? No one knows how severe it is as a biopsy hasn't been done.

So here's something for you to think about. As a medic or soon to be medic: would you rather know about everything? Know exactly WHY the scans are being done and what are the results. Reasons behind all the investigations. All the plans from the doctors and suspicions/differentials. Then you look at it from another point. If this patient knew about all of the reasons and all the prior suspicions that the doctors had, would he still be as relaxed and calm about his "headache"? So is it actually better to not know that much?

Personally I think there's a fine line between knowing too much and knowing too little. As a patient, I would want as much info as I can as I'm a medic - I want to know things. If I didn't have any medical background, I think I wouldn't want to know anything. Live life in denial and in the unknown I guess? At least I won't be busy stressing myself out. These things can be emotionally difficult and cancer is such a sensitive topic. I would think the general population wouldn't want to know all the reasoning. It's tough. I think every person has a different view on this. Something for you to think about/reflect about.


  1. hi, i'm ash,
    so you think the doctors are doing the right thing? hiding all the info until they find the primary tumor?

  2. Very interesting post. I guess it depends on the individual, does someone want to live for today or would they dwell on the future? I volunteer at a hospice for terminally ill people, some of whom have brain cancer. I've been quite shocked at how rapidly some people can deteriorate and how it affects their lives. For me I think I would rather know so I can live life to the fullest.so to speak whilst I can, but I can very well understand why people would not wish to know. Do you find it difficult emotionally in these situations as a medical student/future doctor?

  3. Mmm interesting question. I agree with the previous commenter that it depends on the individual. Some people would probably deal with things better if they knew in advance whereas that may limit others and cause them to be more negatively affected by 'knowing more'. Personally I would like to know more but I don't know whether that is due to the fact that I am a medical student - I just think that understanding the reasoning behind something makes it easier for me to cope with it.