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On Being a Doctor |

An Uneasy Understanding

Adrienne E. Shapiro, MSc
[+] Article and Author Information

From Johns Hopkins School of Medicine, Baltimore, MD 21205.


Note: All names have been changed.

Requests for Single Reprints: Adrienne E. Shapiro, MSc, Johns Hopkins School of Medicine, MSTP Office, Suite 2-300, 1830 East Monument Street, Baltimore, MD 21205; e-mail, ashapiro@jhmi.edu.


Ann Intern Med. 2007;147(11):811-812. doi:10.7326/0003-4819-147-11-200712040-00016
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One month into medical school, I arrived in the ultrasound suite to join Dr. Braun for the afternoon. As the preceptor assigned to me for my first year, she would provide me with most of my clinical instruction in the first-year curriculum. Ultrasound was her only clinic time that didn't conflict with my class schedule, so I showed up prepared to learn about nuchal widths and intrauterine growth. Dr. Braun had reassured me that I would spend some time in labor and delivery as well. Still, in the sonogram suite, I fought gamely to hide my dismay that my first patient would be a moving image on a screen. So much for learning about the doctor–patient relationship, I thought.

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Commentary
Posted on December 29, 2007
Maria N Stack
Yale
Conflict of Interest: None Declared

Ms. Shapiro:

...use of the word termination in the setting you wrote about seemed cold and cruel and made me feel uneasy. I wondered whether the timing of finding out about their baby boy carrying a serious medical condition to the discussion that followed would have allowed the parents enough time to care and grieve for their baby or were they even offered another confirmatory test or a second opinion to make sure that the diagnosis is accurate. I remembered it differently with my friend.

It was March of 2004 and she was expecting her fourth child. An earlier ultrasound had confirmed that they were expecting a girl, Sarah Rose. The level 2 ultrasound news was not good and they were told that the baby had Trisomy 13. This genetic malformation would result in cardiac problems that would make a normal delivery very difficult for Sarah Rose. My friend was prepared to have a C-section so that the baby would have an easier time at birth. In April on a follow-up visit, no heart beat was detected and my friend was admitted to deliver her. I was there when the doctor brought Sarah Rose, perfectly formed and small at 8 months. I attended her funeral service with her parents, older brothers, and sister and grieved at the loss of this beautiful baby. Her loss, perhaps, made the birth later of her sister, Mary Jo, that much more of a miracle and precious...

These parents were expecting a child with so much anticipation that they were not able to refrain from finding out that the baby was going to be a boy. Their baby was diagnosed with an encephalocele by ultrasound. Though life would be uncertain and difficult both for the parents and the child, such occurences are not rare. The parents should be given enough information and time to make the decisions needed and not rushed... ..It is a valuable skill to give bad news to our patients in a caring manner. It is also our privilege to guide them in the decisions facing them and to allow them enough time to make those decisions wisely....

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