Opening Case Study
“Right out of the blue” is how Gina described her diagnosis after her physician, Dr. Bennett, informed her that she was being diagnosed with Type II diabetes. While her mother had suffered from the same condition, Gina had hoped that somehow she might be spared but, as her physician had explained to her, “Type II diabetes isn’t uncommon for someone who is overweight and not getting any exercise.
“But I am only forty-two. This isn’t fair,” Gina had argued.
“Type II diabetes can strike anyone who isn’t taking care of their health, at any age,” her physician had answered. She then informed Gina that she would need to begin using an anti-insulin agent on a daily basis, and that the healthcare team would also be talking to her about the diet and exercise routines that the physician recommended.
Keep in Mind: Gina’s first reaction to her diagnosis was that, at the age of 42, hearing a diagnosis of a chronic condition seemed unfair to her. As a healthcare professional, you may be expected to address this concern when you sit down with her to discuss her treatment plan. How would you prepare for this discussion?
Dr. Bennett described Gina’s medication regimen, and then told Gina that she wanted her to talk to one of the clinic’s nurses, Shelly, before she left.
When Shelly walked into the examination room, she realized immediately that Gina was confused and upset. Gina had been sitting on the examination table when Dr. Bennett had given her the diagnosis. She had a fearful expression on her face, and she sighed and slumped forward.
“How are you doing, Gina?” she asked.
“Not so good. I’m feeling kind of lost. I just received a diagnosis I didn’t expect to receive. I’m not even sick, and now I’m supposed to be on medications for who knows how long.”
Stop and Consider: What do you think Gina needs at this point? How comfortable would you be with a patient who is feeling this way immediately after a diagnosis? What would you do next?
“Looks to me like we need to go over the discussion you had with Dr. Bennett,” she said, and gestured toward a chair. “You don’t look so comfortable sitting on this table. Why don’t you have a seat over here first, okay?”
Gina nodded and moved over to the chair. Shelly pulled up a chair and sat across from her.
“So you just got diagnosed with Type II diabetes,” Shelly said. “Why don’t you start by telling me what the doctor told you.”
Gina took a deep breath, and briefly told Shelly what the doctor had told her about her diagnosis, how it would be treated, and what kinds of lifestyle changes she would need to make. As she talked, Gina choked back tears. “I can’t believe this is happening to me! And who knows what might happen when I get older. I could end up blind!”
Shelly handed Gina some tissues, and she wiped the tears out of her eyes and blew her nose.
“You’re really upset about this, Gina.”
Gina nodded.
“And right now,” Shelly continued, “this all seems really overwhelming and scary to you.”
“Yes, it does,” Gina answered.
“A new diagnosis always brings up a lot of emotions,” Shelly said gently. “It’s scary to have someone give you a medical label, especially when it’s unexpected.”
Gina nodded in agreement.
“So let’s talk about what scaring you,” Shelly said. “And then I’m going to give you some education about Type II diabetes, and go over your treatment plan with you. Does that sound like a good idea?”
“Yeah,” Gina answered. “That’s a good idea.”
Introduction
“We need to talk about your test results.”
This is a sentence that can strike fear in the heart of a newly-diagnosed patient because it brings to mind all kinds of scary possibilities, both real and imagined. How the diagnosis is initially presented to the patient, and how the healthcare team communicates with the patient during the days and weeks that follow, can make a tremendous difference in how the patient reacts and subsequently copes.
Hearing the news of a medical diagnosis, whether expected or unexpected, is in many ways a life-changing experience for the patient. And as a healthcare professional, delivering the initial diagnosis, or talking to the patient immediately after he/she has been diagnosed, is most likely only the first of many difficult but important conversations. Whether delivered by a healthcare provider or healthcare professional, the conversation delivering the initial diagnosis will be followed by other conversations, conducted between the patient and the nursing staff, as well as other allied professionals, such as physical therapists, medical assistants, and dieticians.
Health professionals will have both initial and ongoing involvement with patients who have been newly-diagnosed with medical conditions. Whether minor, acute, chronic, or life-threatening, patients experience a wide range of reactions. Their reactions are dependent on the severity and duration of the condition. At the time of the diagnosis, patients experience emotions that include fear, anger, and sadness. They may feel overwhelmed by the critical treatment decisions that are presented to them, and feel that they have neither the information, nor the mental capacity, to make these decisions. Treatment recommendations may seem confusing, and the patient may need to listen to, and evaluate, medical information that is both confusing and frightening. If the illness is serious, patients may have questions about their future, and have a crisis that is spiritual in nature. Support for practical and emotional issues, and the roles of family and friends, will most likely arise at some point.
Healthcare professionals can have a positive impact on patients from the moment the diagnosis is given which will, in turn, enhance the therapeutic relationship.
Keep in Mind: Have you ever experienced receiving a medical diagnosis yourself, or have you gone through this experience with a loved one? Each patient is an individual, and their experience of a medical diagnosis may be very different than yours. Keep an open mind so that you don’t assume how a patient is reacting.
Figure 1-__
An illustration of a patient surrounded by thought bubbles, that might include ‘Is this the end?’, ‘Will I be normal?’, ‘How will people treat me?’, ‘Can I still work?’, ‘What about my future?’
The Patient’s Mindset: Anticipatory Anxiety
Patients approach news about a medical diagnosis with what mental health professionals call ‘anticipatory anxiety.’ They worry about what they might hear, what it might mean for their daily lives and the lives of their loved ones. They worry about the future, if it will be altered in some way or if they won’t have one at all. Anticipatory anxiety is often experienced through questions that go through the patients mind, mainly questions that are not based on information or even reality but on scenarios that the patient creates to prepare him or herself for the news.
A number of questions go through the mind of a newly-diagnosed patient. And accompanying these questions are images of what their life might be like with this diagnosis, images that are often based on incomplete or false information. To complicate matters, these images have been accumulated throughout their lifetimes. For example, someone who experienced having a parent or relative face an illness – a chronic condition like diabetes or a more life-threatening illness like cancer – may have specific memories of what person going through. These images accumulate over the years and, when faced with their own medical diagnosis, these images can ‘bubble up’ again.
Unfortunately, experiences with someone else’s illness most likely have little or no similarity with what a newly-diagnosed patient may face. Yet, the end result is that patients will have a range of assumptions, and fears, about their own diagnosis, based on these past experiences. They may easily be flooded with these images and memories even before they receive their diagnosis. Consequently, newly-diagnosed patients may be ‘primed’ to expect the worst, and armed with a range of assumptions.
Because patients come to their diagnosis with these assumptions, the healthcare team is in some ways talking to two people when they give a medical diagnosis:
- The person sitting in front of them who is newly-diagnosed, most likely with no past history of this condition and therefore no basis for experience.
- Another person who has a collection of scary images and assumptions, and who may already have decided what they think life will be like before they have even heard the diagnosis.
The challenge for the healthcare professional is that while they are speaking to the first person, it is the second person who has prepared for hearing the diagnosis.
Here are the key questions that may pass through the mind of a newly-diagnosed patient.
What will my daily life be like? Will I be normal?
As a child, John watched an aunt cope with chronic pain. He remembers how uncomfortable she always seemed to be a family gatherings and how she would have difficulty smiling or participating in conversations. He remembers how his uncle had to help her with simple things during dinner, like putting food on her plate and cutting her meat. Often, she and her husband would excuse themselves and leave early because her pain had increased.
Being normal is being able to do the little things in life, including self-care, participating in work and leisure, and caring for others. This means going to the grocery store, keeping our homes clean, going to work, participating in family and work activities, enjoying hobbies… lots of little things that, when added together, make up our own unique lives. Basically, we all want to be normal in whatever way we define this word.
For most of us, being normal means standing out from the crowd in a way that we don’t want to stand out – looking different, acting different, needing special assistance, or having to eat foods that are different from what everyone else is eating. A medical diagnosis can raise all sorts of questions regarding one’s potential normalcy going forward in life, and what that is going to mean for ourselves and the people we care about.
What will change in my relationships? Will people treat me the same?
Taylor once read a story about a woman with breast cancer who had to ask a relative to take her two small children in to live with her because she was temporarily unable to care for them herself. Taylor, who has a child of her own, remembers crying after reading this story, and even dreaming about it.
Sigmund Freud said that the goal of a human being is ‘to work and to love.’ Human beings are social beings, and newly-diagnosed patients worry that their illness will interfere with their personal relationships with their family and friends.
Parents wonder if they will be able to adequately care for their children or if their condition will cause shame or embarrassment for their children in some way. For a parent, this may be the greatest tragedy that they can imagine.
They worry that their partners will not be as attracted to them, or if they will not be able to maintain their responsibilities in the household, or if they might require more support than their partner is willing or able to give.
Newly-diagnosed patients may fear that friendships may suffer in some way, that their friends may be uncomfortable with them, or not know how to talk to them about their condition, and that they will lose their friends as a result of the diagnosis. No one wants to feel like an ‘outsider’ in some way, or that they are being avoided.
They fear that their lack of being normal also means being ‘less than’ other people, having to be treated differently and, at the worst extreme, being a burden to other people in some way. For example, they worry that others may avoid them or, at the other extreme, try to take care of them as if they were a child.
What will happen at my job? Will I still be employable?
Anna has a high-pressure job in an advertising agency. She has always worked long hours but also tried to eat healthy. But lately she has been experiencing some pain that has worried her. She watched her mother’s condition gradually deteriorate after being diagnosed with arthritis, to the point where she had to rely on others to handle daily tasks like housekeeping. This is the memory that Anna holds in her mind as she waits in her doctor’s examination room.
Sigmund Freud understood the importance of being able to work as integral to achieving a sense of being a valuable part of the world, whether it is in a job outside of the house or in the workplace. The truth is that we gain much of our identity through what we do, and we evaluate others based on what they do as well. In today’s world, there are many who perhaps work too hard, and derive too much of their identity from what they do for a living. Anna may be one of these individuals.
And it is important to keep in mind that we work to support ourselves, to provide the basics but also to enable us to live a certain lifestyle and to pursue our interests. Those with families to support have an even higher stake in maintaining the ability to work – they have others whose daily lives are dependent up the money they earn.
Consequently, it is not uncommon for newly-diagnosed patients to approach their diagnosis with fear based on the fear of loss of work alone, and to be filled with images of others with whom they have come into contact with in the past who were experiencing loss of profession.
What can I expect in the future? And do I even have a future?
Jerry is all about the future, as he is the first to admit. At age 32, he is filled with dreams of what he is going to do with his life. Already, he is the owner of a successful small business that he maintains while working full-time, and has been planning to take the next big step within the next year, which is to leave his job to make his business his life’s work. But he finally decided he had to call the doctor when the lump he discovered didn’t seem to be going away. He hasn’t met with the doctor yet. Still, he’s asked himself: Am I going to finally get what I have been working for, or is it all going to go up in smoke?
No one knows what the future will bring. But human beings assume they will have a future, and they assume that they have some kind of control over what the future brings. Living a good life, working hard, being close to friends and family… these actions are all supposed to create the basis for getting what we want in life. Furthermore, having plans for the future adds meaning to whatever discomfort or disappointment one might currently be experiencing in jobs, living situations, or relationships that don’t seem to be going well at the moment. After all, there is always tomorrow, and doing the right things will bring a better tomorrow.
The possibility of hearing a medical diagnosis that might interfere with future plans can be daunting. A patient contemplating a medical diagnosis most likely equates the potential diagnosis with lack of control, not being able to do things necessary to have a future. And without a vision for the future, what’s left?
Other Factors Affecting Readiness to Hear a Diagnosis
Other factors may affect how ready a patient is to hear a diagnosis. These factors are being briefly introduced here, and will be elaborated upon in further chapters as well.
Denial
Denial is a common response to a medical diagnosis. However, it is also a phenomenon that occurs even before the diagnosis. Patients may prepare themselves to hear a diagnosis by promising themselves that ‘it won’t happen to me.” Or, they may tell themselves that if the diagnosis is confirmed, or it is an unexpected diagnosis, they won’t believe it, or it ‘won’t be as bad for me as it was for someone else.’
Superstitious Thinking
Human beings have all sorts of superstitions that they engage in, and these include a number of them around illness. One of the more common examples of superstitious thinking is to the belief that if one is kind enough to other people, nothing ‘bad’ will happen to them. Therefore, it is not uncommon for patients to report having done an extra kindness, or made a large donation, when faced with the possibility of a medical diagnosis. On the other hand, assuming the absolute worse is another example of superstitious thinking. For example, a patient waiting to hear about a medical diagnosis may self-diagnosis with the most catastrophic condition possible, hoping that with this diagnosis in mind, whatever they are faced with will be relatively minor by comparison.
Pre-Bargaining
Patients facing a medical diagnosis may indulge in a process of bargaining, which is another form of superstitious thinking, but one that can result in denial, on one hand, or in their being especially devastated. Men or women with children may, for example, promise to be exemplary parents, if only… Other promises might involve following through on plans to obtain further education, or to get more involved in community affairs. Essentially, the goal of pre-bargaining is to make a promise – to oneself, one’s loved ones, or to a spiritual Being – such that a medical diagnosis would have a negative affect on the world.
Keep in Mind: Patients’ current thought processes and expectations as they anticipate being presented with a diagnosis have a direct impact on their ability to understand and process this information.
Figure 1-__
A healthcare professional sitting with a patient.
Giving a Diagnosis
Depending on the type of diagnosis, and its severity, as well as the standard procedures in the hospital, clinic, or private practice setting, guidelines may be in place in terms of how a medical diagnosis is given and by whom. However, the intention of this section is provide some guidelines for giving a diagnosis from the perspective of helping the patient to hear and respond in a way that will facilitate further discussion.
As alluded to at the beginning of the chapter, a diagnosis that may be routine for the healthcare professional, is anything but routine for the patient. Even the most common diagnosis can be devastating for a patient, especially given the state of mind that a patient may be in when the diagnosis is given. Furthermore, healthcare professionals may feel like a condition is readily treatable and, as such, should not be overly frightening for the patient. Additionally, healthcare professionals may be unprepared to provide more than the basic facts to the patient, or be limited by time, or feel that it is best to simply provide the essentials and leave the patient to pursue additional information, as well as help in emotional coping, on their own. And finally, physicians often feel that the other staff members, especially the nurses or medical assistants, are better equipped, and have the time, to further elaborate on the diagnosis and help patients with any needed assistance in coping.
Openness to Emotions
When giving a medical diagnosis, here are some key points to keep in mind:
Patients may or may not be expecting even to hear a diagnosis. And if they do have expectations, they may experiencing emotions like fear on one hand, or they may be in denial, on the other. Nursing staff can begin the conversation by understanding how the patient may be feeling emotionally. This signals to the patient that the healthcare professional is concerned about their well-being and comfortable talking about feelings.
Review of Reason for Referral
It can be helpful to patients if the healthcare professional briefly reviews with them why they are there. The patient may have referred him or herself, for reasons that include a routine physical to complaints about symptoms. Or the patient may have been referred by another source, such as a physician or clinic. Reviewing the reason for referral helps to remind patients of what brought them to this point. It is always a good idea to gain agreement with the patient on their reason for referral, especially when some time has passed between the initial contact and when the diagnosis was determined.
Basic Understanding of Diagnostic Procedures
Following the review of the reason for referral, it is recommended that the patient be provided with an overview of the diagnostic procedures. Patients don’t need to understand the science or the technology behind any diagnostic procedures that were used, and to much technical information can be overwhelming, and scary, to a patient. However, it is helpful for patients to have a basic understanding of why certain procedures were chosen, how widely used they are, and how reliable they are, and the preparation involved prior to the procedure and after the procedure. The discussion of procedures should be related back to the original reason for referral, any relevant aspects of a patient’s medical history, and the reliability of the procedures.
Keep in Mind: Readiness is an important factor in a patient’s ability to listen – and to hear – information that is presented. While the patient is waiting for the diagnosis and may have some resistance to any discussion that precedes it, once the diagnosis has been presented, the patient may also have difficulty in taking in information that follows.
Presenting the Diagnosis
With the reason for referral and the diagnostic procedures briefly reviewed with the patient, it is now time to provide the actual diagnosis. While medical diagnoses vary widely in terms of symptoms, treatment, and degree of risk, it is important to present the diagnosis, as much as possible, in language that the patient will understand.
After providing the diagnosis, it is recommend to immediately give the patient an opportunity to express reactions to the diagnosis. Some patients may have an emotional reaction, others may seem to have no reaction at all, and still others will want to ask questions. If he/she has any questions about the diagnosis, these should be answered in as terminology that is understandable. It is recommended that the healthcare professional presenting the diagnosis should make sure the patient understands the basic diagnosis before moving on in the discussion.
Healthcare professionals give diagnoses and medical information on a routine basis. Consequently, they may speak so fast that the patient is not able to keep up. This process is anything but routine for the patient. Therefore, being sensitive to the patient extends to making sure the discussion is conducted not only in terminology that the patient can understand, but also slowly enough for the patient to take it in.
Generally, patients will have immediate questions regarding the prognosis, the treatment, and the recovery process from both the treatment and the condition.
Figure 1-__
A patient looking at a treatment plan with a healthcare professional
Presenting the Treatment Plan
Newly-diagnosed patients want to have a sense of hope. Realistically or unrealistically, they will be looking for this from the healthcare professional’s discussion of the treatment plan. It is important to discuss the treatment plan, or the treatment options, in straightforward terms, highlighting the treatment process itself, what to expect in terms of side effects and impact on daily life management, and the likelihood of success. Keep in mind that patients may not be ready to talk about treatment options and, especially, to make a decision regarding alternatives. Patients at this point may not want to have this discussion.
In this regard, discussion of the treatment plan may be an ongoing process. As patients cope with their initial reactions to the diagnosis (more on this in Chapter Two), and do more of their own research, they will also have more questions. Even if the physician provides the initial diagnosis, members of the healthcare team may be called upon to answer questions about the treatment, especially in regard to side effects and recovery. And the healthcare team may be involved with, if not primarily responsible for, the ongoing treatment administration and supportive care, so it is beneficial for the patient to begin discussing the treatment with the nurses or medical assistants as soon as possible to begin establishing this relationship.
Discussing Emotional Reactions to the Diagnosis
The missing aspect of the discussion of a medical diagnosis is the patient’s emotional reaction. Emotional reactions are complex, and will be discussed at length in future chapters.
At this point, it is important to emphasize that this is an emotional experience for patients. All too often, out of time constraints, lack of training, or their own personal discomfort, healthcare professionals are not open to discussion emotional issues with patients. They fear that the discussion may get ‘out of hand’ and that they will be required to deliver mental health services which they are not qualified to deliver. Or they may feel that patients need to be focused on information and treatment decisions and not allowing themselves to become enmeshed in emotional reactions.
Healthcare professionals can make it clear that they understand that learning about a medical diagnosis can be an emotional experience. A simple question such as, ‘how are you doing with this?’ can provide an opportunity for the patient to express some of their initial reactions, at least enough to feel a sense of release during this potentially traumatizing experience.
As you will see going forward, simply having the opportunity to express feelings and be heard is the beginning of the journey in coping with a diagnosis.
Providing Next Steps
Patients need to leave the discussion of the medical diagnosis with a sense of what they can and should do next. This includes next steps regarding:
- Patient education information to read
- Where to go/whom to call for additional information
- When treatment begins and what to expect
- Guidance on any lifestyle modifications
- A referral source for mental health counseling, if potentially needed
- Any additional specialists or tests that needed to be scheduled
- Websites to visit for more information
- Information on medications
Keep in Mind: Patients are first and foremost unique human beings. This means that each patient goes through their own process in terms of acknowledging and accepting their diagnosis, coping with it emotionally, getting educated, and moving forward with treatment and lifestyle modification decisions. Let them know that you understand this, and that you are standing by as questions arise.
Discussing a Recent Diagnosis
The healthcare team is often in the position of meeting with a patient after the initial diagnosis has been delivered by the physician. As we saw at the beginning of the chapter, when Gina received her Type II diabetes diagnosis, patients often require additional discussion of the diagnoses following this conversation. There are a number of reasons for this need. Patients often experience some initial shock at the diagnosis, and are consequently not ready to hear more or otherwise do anything beyond sit with their emotional reactions. The physician may not have time at that moment to remain with the patient and answer further questions and may indeed be relying upon the healthcare team to handle these conversations. The healthcare team is in a unique role, as a primary interface between the patient and the physician, to have these discussions.
Essentially, a meeting with a patient who has recently received a medical diagnosis can be conducted in very much the same manner as the discussion in which the diagnosis was originally delivered. In fact, patients may have to have the complete discussion over again, from the diagnosis, to treatment, to next steps. They may have been so distraught that they weren’t able to listen to the diagnosis the first time, or they may have been in a state of denial or disbelief. Patients may be so caught up in their anticipatory anxiety, and all of the perceptions and misperceptions of the diagnosis that they have accumulated, that they hardly heard what the physician said beyond the diagnosis. Or they, patients may simply need to go through the discussion again simply to help them to process it.
Preparing to Deliver a Diagnosis to a Patient
As you prepare to deliver a diagnosis to a patient, here are some points to keep in mind:
- Do I understand the condition?
- Am I prepared to discuss the treatment, and the treatment options?
- Am I armed with patient education material?
- What are the potential concerns that the patient may have, including side effects of treatment, duration of treatment, expected outcomes of treatment, required lifestyle modifications, potential of recurrence.
- Do I know where I can send the patient for more information?
- How might the patient react emotionally? Am I prepared to discuss the patient’s emotional reactions?
- Do I have a referral source that can help the patient cope with emotional reactions?
- What are the next steps that I need to go through with the patient?
Figure 1-__
Gina and Shelly have a conversation.
Rx: Discussing the News of a Diagnosis with a Patient
Early on in the chapter, we left Gina with Dr. Bennett’s nurse, Shelly. After Gina moved into a comfortable chair, and Shelly sat across from her, here is the how the conversation progressed.
Shelly: So where would you like to start, Gina?
Gina: With how I got to this point.
Shelly: Would it help if I started from the beginning?
Gina: Yes, I think it would.
Shelly: Well, you came in for your annual physical and I was going through the standard health questions with you. You said that you had been more thirsty than usual lately, and that you felt tired a lot. Do you remember that?
Gina: Yes, I do.
Shelly: And you checked the box on the questionnaire that indicated that your mom had suffered from Type II diabetes. Right?
Gina: Yeah, she did. From about her early fifties onward. She was on medication until she died last year.
Shelly: That was a red flag. Dr. Bennett scheduled you for some additional tests to check your blood glucose levels. She received the results, and you were diagnosed with Type II diabetes.
Gina: I just can’t believe this is happening to me. I mean, I knew it was possible, but somehow I thought I might escape it.
Shelly: I know this is upsetting for you. What are your biggest concerns?
Gina: I’m worried about what my life will be like. If I am going to have to change the way I live, not eat the food that I enjoy. And I’m worried about what this might mean as I get older. I mean, my mother had a lot of stuff happen to her as she got older.
Shelly: Type II diabetes can be controlled. The medication will help. And I can recommend diet and exercise that will work with your lifestyle. What else is on your mind?
Gina: I’m just scared, and angry at myself for letting this happen.
Shelly: You don’t have to beat yourself up over this, Gina. I know it’s disappointing.
Gina: You don’t know how disappointing. I feel like I have this cloud that’s going to keep following me around, and I have to keep paying attention to it. But no matter what I do, it’s not going to go away.
Shelly: It’s always disappointing and scary to hear about a medical diagnosis. Nobody likes that. Especially a chronic condition like diabetes. Yes, it’s going to be around. But we can work together to make sure that you take the best care of yourself that you possibly can.
Gina: Okay.
Shelly: And if you would like to talk to a counselor, I have a couple of names I can give you. It might be really helpful to you to have someone to talk to about this. You can think about that if you want.
Gina: Okay, I will.
Shelly: Now, do you want to know more about the medication?
Gina: I know what I need to take, and the doctor gave me a pamphlet to read. I think I have dealt with enough for today.
Shelly: Okay, you know how to call me as questions come up. But the doctor wants you to start the medication as soon as possible, and we need to go over some diet and exercise recommendations. Are you ready to go over that with me for a few minutes?
Gina: Sure.
Figure 1-__
An illustration of stair steps, labeled according to the sub-heads below, including Review Facts, Listen, Recognize Emotions.
Guidelines for Discussing a Diagnosis with a Patient
The following are guidelines for discussing a recent diagnosis with a patient:
Review the facts.
Newly-diagnosed patients are often not able to take in much of what their physician tells them about their diagnosis during the initial conversation. They often hear very little during the conversation beyond the name of their medical condition. Therefore, it can be helpful to review the facts with the patient. Notice that, in the above example, Shelly started with what prompted Gina to make an appointment – an annual physical which was accompanied by a discussion of symptoms that Gina was experiencing, as well as her family history of diabetes.
Listen to the patient’s initial fears.
Patients often have initial concerns regarding their diagnosis, and these concerns are top-of-mind for them. Concerns can be so pronounced that they are unable to completely focus on anything else the healthcare professionals tell them until they have had an opportunity to at least express these concerns. The healthcare professional may or not be able to offer resolution at this point in time, nor is it necessary. Providing them with the chance to voice what they are thinking and feeling, and reassuring them that these concerns will be addressed, can at least provide some sense of relief. Notice that Shelly listened to Gina’s fears and then reassured that they would work together to help her to stay healthy.
Recognize – and acknowledge – when a patient is overwhelmed.
Newly-diagnosed patients may be so overwhelmed by the news of the condition that they are not able to fully focus on further discussion until they have had an opportunity to process what they have heard. They may indicate that they are overloaded by not responding to what questions or comments by the healthcare professional, or otherwise making it obvious that they are no longer listening, or through the expression of emotions reactions like crying. Shelly was watching for signs that Gina might be overwhelmed because, at one point in the conversation, she offered to give Gina a referral to a counselor. If a patient becomes so overwhelmed that the conversation cannot continue, it may be necessary to reschedule it.
Keep in Mind: It can be helpful to patients when the healthcare professional ‘normalizes’ their condition by reassuring them that they are reacting to their diagnosis in a manner that is similar to the ways in which other patients react, and that others have also managed to cope with this process.
Picking Up the Pieces After the Straight Talk Express Has Passed Through
As a member of the healthcare team, you may find yourself in the position of stepping in after a healthcare provide or another healthcare professional has delivered a diagnosis in a direct, ‘just the facts’ manner that the patient was not emotionally prepared to hear, or who has been unable or unwilling to acknowledge the patient’s emotional reaction. When this happens, you may feel like you are essentially ‘undoing’ the damage that may have been caused by the manner in which it was originally delivered. When this happens, it is recommended to begin the conversation by providing the patient to recount what he or she experienced when the diagnosis was first delivered – what they heard, understood, felt. This may feel like a ventilation session and, essentially, it will be. But the patient needs to be listened to and to have a chance to put this experience in perspective – to process it – before moving forward.
At this point, it is advisable to go through the process of delivering the diagnosis from the beginning to assure that the patient has all of the information as well as the opportunity to react within the structure of a best practice approach to this conversation.
Summary
The process of helping a patient to cope with a medical diagnosis begins with the moment when the medical diagnosis is delivered. Patients experience anticipatory anxiety – much of which is based on past encounters with illness in other people as well as lack on information – as they approach this conversation. Healthcare professionals can help patients through this process by delivering the diagnosis in a manner that is sensitive to the lack of information of patients, the need to hear and process this information that is consistent with each patient’s readiness to cope, and sensitivity to the emotions that a patient may be experiencing. Healthcare team members can facilitate the process of helping patients to process this information as they deliver the diagnosis, or as they follow up on the physician’s delivery of the diagnosis.