Tuesday, January 28, 2014

Dr. Orthochick: Bad Reaction

Me: Well, I looked at your x-rays and you broke your shoulder--

Patient: Oh my G-d, really? I think I'm going to throw up.

She then threw up.

Never had anyone have that reaction before.


  1. An outpatient musculoskeletal medicine rotation reminded me that I need to preface bad Ortho news (even news that really isn't that bad in the grand scheme of bad inuries) similarly to how I preface bad news about other major medical conditions like cancer or spinal cord injury prognosis. Broken bones and torn ligaments do significantly affect a patient's quality of life and ability to live their normal lives, even when the problem can eventually be fixed.

    On that rotation, some people took the bad news just fine, but a few of them responded with such despair that felt like I'd shattered their psyches with their X-ray or MRI results. One woman sobbed uncontrollably for the entire visit no matter what I told her about next steps to heal her (totally manageable) condition.

    Now I aim to use the "breaking bad news" principles that they taught in med school rather than bluntly giving them the bottom line. If they seem like they want the facts then I am more blunt/succinct in the rest of my delivery. I'm careful to share what they can expect and try to emphasize aspects that might give them some hope for recovery. It takes a little more time (which of course is not reimbursed...), but at least I don't feel like a heartless bastard at the end of the day.

  2. How do you even respond to that?

  3. http://goggles.sneakygcr.net/gallery/2014/1/28/bc748402e27e760a3c9545b94007896fd9fe6940

    My rendition of your cartoon

  4. When my rugby-playing brother managed to get his hand stepped on by another player, he very appropriately got an xray - and fainted when he saw it. He fainted again when he learned he would need surgical fixation.

    Of course, years earlier when I was about 4 years younger than him, I got hit in the face by a softball and managed to get a displaced zygomatic arch fracture and multiple nondisplaced orbital fractures. I was scared that I needed surgical repair, but didn't get vagal let alone pass out.

    You can guess which one of us is in medicine and which is in the insurance industry. ;)