■ Physician-patient:

Communicating effectively with patients to optimize their care

Missed mammogram

Type of activity: Video

Activity summary

The short video "Missed mammogram" portrays a scenario in which a family physician discovers a filed mammogram result 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.

Transcript

Setting: Family physician's office with 2 characters - Kathy, a patient, and Dr. Smith, a female family physician.

Dr. Smith: So Kathy, how are you?

Kathy: I've been kind of worried. I found a lump in my left breast. I've been really busy moving mom and dad to the seniors' apartment. They can't handle the house right now and with the kids away at university, they still need a lot of TLC so I haven't paid much attention to myself lately.

Um, I think I had a mammogram about 6 months ago, and when I didn't hear anything, I just forgot about it until I found the lump.

Dr. Smith: Well, let's take a look at your chart. (looks through the chart) Well, it seems your mammogram was 18 months ago and it was filed and as my initials are not on it, I don't think I reviewed it.

Kathy: What do you mean? What does it say?

Dr. Smith: The radiologist thought there was a few abnormal calcifications and suggested further testing. However this is the first time I have seen this so we did not order any further investigations after your last mammogram.

Kathy: Does that mean I have breast cancer?

Dr. Smith: We can't jump to that conclusion just yet. The report just says 'suspicious' not diagnostic. You shouldn't put the horse before the cart.

Kathy: How could this happen? Why didn't anyone tell me? You told me 'No news was good news.'

Dr. Smith: We have a protocol that all results get reviewed by me. I initial them and give them to staff for further direction.
I really don't know how this slipped through without me seeing and acting on it.

Kathy: I can't believe this could happen. I trusted you to take care of me all these years. What about the people in X-ray? Don't they follow through on things? If they see something suspicious aren't they supposed to call you or me?

Dr. Smith: That should happen, so it was probably the office staff not following up on protocol or it was radiology not following up on abnormal findings like they are supposed to according to the department protocol.

Kathy: Oh no, I probably have breast cancer. Who is going to take care of mom and dad and the kids? You know my ex isn't reliable.

Dr. Smith: I understand you're very upset about this. I think we really just need to get some answers first before we think the worst. I'll speak to radiology and I'll book you in for a mammogram as soon as possible. They'll do special views, anything else that needs to be done. You'll be taken care of. Any questions?

Kathy: I'm still having trouble understanding how this could happen. I don't know what to do. I don't know what to say.

Dr. Smith: Just calm down and get the tests done and we'll take it from there.

Pause

(exits room, turns and speaks from doorway) I'm really sorry this happened to you.

Concluding facilitation question: What could have been done better in this scenario?

Facilitation questions

  1. What could have been done better in this scenario?
  2. Does this represent a disclosure discussion? Discuss.
  3. Did the physician meet the patient's clinical, emotional and information needs? Discuss.
  4. How could the family physician have better disclosed the situation?
  5. Was the apology appropriate in this situation? Discuss.

Suggestions to faculty

In small groups, have learners role play disclosure of the missed mammogram result to the patient. Ensure the disclosure conversation includes consideration of the patient's clinical, emotional, and information needs.

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.