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On Being a Doctor |

Deflection of a Diagnosis

Paul Rousseau, MD
[+] Article and Author Information

From Glendale, Arizona.


Requests for Single Reprints: Paul Rousseau, MD, 17 W. Vernon Ave., Phoenix, AZ 85003; e-mail, PalliativeDoctor@aol.com


Ann Intern Med. 2007;146(2):146. doi:10.7326/0003-4819-146-2-200701160-00011
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He sits there, a skeletal silhouette, his body reminiscent of a Holocaust victim, his eyes closed halfway to death.

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Letter to the Editor
Posted on January 25, 2007
Paul C. Rousseau
VA Medical Center, Phoenix, Arizona
Conflict of Interest: None Declared

To the Editor

The Annals of Internal Medicine recently published a piece I wrote for the On Being A Doctor series titled "Deflection of a Diagnosis" wherein I described the difficulty a physician experienced informing a terminally ill patient that he was dying"”in fact, the physician was unable to tell the patient, instead, deferring the discussion until a follow-up visit scheduled a week later. I have since received a few e-mails critical of my management of the case, however, I was not the physician in the scenario, I was merely an observer detailing this physician's angst in delivering bad news to a fellow human being. My hope was that select physicians would objectively look at their behaviors after reading this narrative and change their patterns of practice to preclude such conduct in future encounters with terminally ill patients. That said, it is nevertheless hard to provide a "death sentence" to patients, particularly for young physicians who are still absorbing the art and wisdom of medicine that accrues with time and age. And certain patients are just not ready to hear the diagnosis the first time, and may require a second, or even third visit. But irrespective of the time frame involved, unless we are totally honest with patients, the physician-patient bond will shatter, and with that, hope for healing.

Paul Rousseau, M.D.

Conflict of Interest:

None declared

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