Re: Bad News

From: D. Ashley Hill (dahmd@cfl.rr.com)
Sun Oct 30 07:49:53 2005

El-

In Florida (and maybe the US) HIV results are "super confidential" and one cannot give results over the telephone, voicemail, fax or email.

My point is that many of us are victims of our training and our personal belief that abnormal results deserve a face-to-face conversation, but patients may not agree. We use an electronic medical records system that generates a letter to notify patients of normal Paps, mammograms and labs, but we either call the patient or ask her to come in for abnormal results. If we call (to expedite any necessary referrals, for example to a breast surgeon), we always offer a face-to-face meeting with the patient and any family members. Interestingly, most decline. To my knowledge, our 8-physician group has never had a patient complain about this system. What patients complained about in the past was receiving a card or letter on Friday afternoon with "your Pap smear was abnormal, please call the office." I suspect patients just want to know the results and, if necessary, get working on a resolution, and as long as one delivers the message effectively and kindly they don't mind which route does the job. Thanks,

Ashley

At Sun, 30 Oct 2005, Dr Eberhard W Lisse wrote: >
>Ashley,
>
>I often have HIV results to communicate, if I refuse to do that over the
>phone bot don't refuse all the time it's obvious...
>
>I do not believe one should compromise oneself (and/or one's ethics)
>because of "issues" which are actually whims. If it is *THAT* important, it
>is *THAT* important. If not, it can wait.
>
>By the way, I only communicate by email when the patient asks fo it, write
>the email address onto the file (herself) and confirms afterwards tha the
>email is correct. I have GPG but very few patients do.
>
>greetings, el
>
>In message <200510292233.j9TMXCY07086@dns.obgyn.net>, D. Ashley Hill writes:
>
>> We may assume that patients prefer face-to-face communication when
>> receiving bad news, but I've had patients tell me that they would rather
>> "hear it right away" than wait (even for a day) to see me in the office.
>> Folks are used to communicating with email and voicemail and telephone,
>> so I don't think most patients would mind a phone call as long as the
>> physician is kind and informative. Also, some patients have child-care
>> issues or can't leave work for a spur of the moment office visit. For
>> some patients a phone call is a much more effective and appreciated
>> method of dealing with bad news. It depends on the patient and the
>> circumstances.

--
D. Ashley Hill, MD
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
 and Loch Haven Ob/Gyn Group
Orlando, Florida



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