Breaking bad news - a GP registrar's experience - GP Synergy

Breaking bad news – a GP registrar’s experience

One ordinary morning, years ago when I was a GP registrar, an elderly couple came in to see me. After I finished seeing the wife, I squeezed in the husband, who was her carer, because he had back pain. I took a history and noticed that he had had routine blood tests this week which showed a high calcium level. The reason for this wasn’t apparent. I proceeded to examine him and was surprised to find he had multiple levels of spinal bony tenderness. The rest of the physical exam including digital rectal examination was unremarkable. I sent him for imaging that day and received an urgent call from the radiologist at lunch-time because he had bony metastases. His high calcium must have been due to the paraneoplastic effect of cancer.  I rang the lab to add on a PSA to his bloods urgently and that too came back as significantly elevated.

The radiologist sent him back to see me that afternoon. This was the first time I had to break such bad news to a patient, by myself, without a consultant or medical registrar watching over me.

I started seeing this lovely gentleman every week, which soon became nearly every day. Then I started doing home visits for him during my lunch breaks because he became too frail to come in to the practice.

As his GP, I felt busy coordinating his care and optimising his symptom management. But my role was more than that. Every time I visited this gentleman’s home, I felt like the whole family was preparing for my arrival. The little gate in the front of the garden was open. Medications were laid out on the coffee table with my hand-written instructions. Cups of tea were recurrently offered. My patient and his family seemed so happy to see me and to have their doctor share their journey.

I had a profound realisation about how much we can help people in our capacities as doctors.

The name of the treating GP has been withheld for privacy reasons.

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