■ Physician-patient:

Communicating effectively with patients to optimize their care

Missed biopsy result

Type of activity: Video

Activity summary

The short video "Missed biopsy result" portrays a scenario in which a family physician discovers a filed biopsy report during a patient visit. The missed result has serious implications for the patient's well-being. The facilitation questions and suggestions to faculty focus on helping learners to identify the key elements of a disclosure discussion and to consider when it is appropriate to offer an apology for a poor clinical outcome.

Transcript

Setting: Dermatologist office with 3 characters - a nurse, Dr. Smith, the dermatologist, and Mr. Jones, a patient.

Nurse: Dr. Smith. Mr. Jones says he has developed a black spot in the biopsy you did on his thigh last year. He also has a lump in his groin. When should we bring him in? He seemed really worried on the phone.

Dr. Smith: (looks through chart) Oh. The report was at the back of the chart. It says there's a 2.5 mm melanoma and recommends a wider re-excision. We're going to need to bring him in later today. I need to discuss this result.

(Later that day...)

Dr. Smith: Hello Mr. Jones.

Mr. Jones: Hello.

Dr. Smith: Thank you for coming in. How can I help you?

Mr. Jones: I'm a little worried because I found a black mark in my biopsy scar and I also found a lump in my groin. I was wondering if you knew what was going on.

Dr. Smith: Let me have a look at it.

(After examination)

Mr. Jones: What do you think, Doctor?

Dr. Smith: I'm sorry to have to tell you this. You have a recurrence of a skin cancer called melanoma and it has spread to your lymph nodes.

Mr. Jones: (angry) How did this happen? You said that if I didn't hear from you everything was fine!

Concluding facilitation question: Does this represent a disclosure discussion?

Facilitation questions

  1. Does this represent a disclosure discussion? Discuss.
  2. Did the physician meet the patient's clinical, emotional, and information needs? Discuss.
  3. How could the family physician have better communicated the situation to the patient?
  4. Is an apology appropriate in this situation? Discuss.
  5. How would you suggest that the physician prevent this from happening to another patient?

Suggestions to faculty

In small groups, have learners role play disclosure of the missed biopsy result to the patient. If they include an apology, remind learners to provide appropriate information and to avoid use of words that express or imply legal responsibility.

Additional resources

CanMEDS: Medical Expert, Communicator, Professional

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.