Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

A physician’s inaccurate cancer prognosis

Anne Katz, RN, PhD
Conditions
January 2, 2020
Share
Tweet
Share

asco-logo Mr. G* was diagnosed with advanced prostate cancer two years ago and has been on a succession of medications to control a progressive cancer. His PSA never nadired after surgery, and adjuvant radiation only increased his urinary problems. Androgen deprivation therapy added to his symptoms, and he is now considering taking a second-generation androgen-receptor antagonist. Fortunately, his cancer has not yet metastasized, and despite the side effects he endures, he makes the most of every day.

He is now 69 years old. The last two years have been busy with medical appointments, scans, blood tests, and visits with me and other oncology care providers to discuss his treatment options. Over the years, Mr. G and I have talked about his life goals. From the beginning, he has always been clear about his goals of care: to live long enough to see his grandchildren grow into adulthood, and to spend quality time with his wife of 45 years, Sheila*, at their lake cottage.

He retired sooner than he had planned after his diagnosis, when he realized that his life was likely going to be shorter than he had hoped, and he doesn’t regret that decision for a moment. He has spent a lot of time with his grandchildren, something he cherishes. He has also spent more time at the cottage with Sheila and has become quite adept at fixing the inevitable breakdowns that occur there.

The last time I saw him, Mr. G was not his usual affable self. He was agitated and had difficulty controlling his voice as he told me about an appointment he had with a new-to-him health care provider at an urgent care facility. He and his spouse were at the cottage when he experienced sudden onset hip pain. His wife panicked and insisted that he see someone. He was pretty sure that the pain was muscular, a result of some work he had done clearing the brush at the end of the yard, but he didn’t want to upset his wife so he agreed to go to the nearest town to seek medical attention. The town was just 20 minutes away, and this seemed a better proposition than the 2-plus hours to get back to the city. In addition, he knew that on a Sunday, he would have to go to the emergency department in the city, and the wait to be seen would be very long.

He was seen quite quickly at the urgent care center; the physician in attendance seemed to take his complaint seriously and wanted him to have an X-ray of the offending hip. He was not convinced this was necessary and suggested to the physician that he was only there to placate his wife and that he would talk to his oncologist the following week when he went back to the city for his usual follow-up.

The response of the physician was unexpected and not appreciated.

“He told me that I have a very serious condition and that I should not take something like pain lightly!” Mr. G recounted. “He also said a bunch of things that got my wife all upset, and that was just not right!”

I asked him if he could recall exactly what the physician had said.

“Well, like I just told you, he told me that my cancer was very bad. As if I didn’t know that! And he said that I probably have cancer that’s spread to my bones … I know that was what my wife was worried about, but now she’s sure that’s what’s happening. He told me that there was pretty much nothing they could do about things if the cancer had spread. He was mad at me because I didn’t want to get the X-ray there, I think.”

I nodded at him and asked him to continue.

“What does he know about my condition? He’s not a cancer doctor! He got my wife all upset, and she got even madder when I walked out of there. She’s been on my case to get the damn X-ray, and so we came into the city early, and I had to go see my usual doctor get the form to get the X-ray and I waited there for almost 45 minutes to get it done. Now I’m waiting to see my doctor, and it’s a whole darn day wasted when I could be at the cottage.”

I asked him about the hip pain.

“Oh, it’s gone, just like I thought. I knew it was from cutting the brush. But you know Sheila—she’s all in a tizzy about this and won’t let me do a thing in the yard out there, and the summer’s so short, and I have things to do before the winter comes …”

ADVERTISEMENT

By now, he was out of breath.

“And you know what the worst thing is?” he asked. “He scared me. And he sure as heck scared Sheila. He said that if the cancer had spread, there was nothing that could be done! That’s not what my oncology doctor told me the last time I saw him. We had this whole long talk about this other medication that could help. I have been so positive all this time, and he just took all that away. Not just from Sheila but from me also! He took away my—our—hope!”

And there it was: the thing that had him so upset. One sentence from a stranger had taken away the hope that this man and his wife had for the rest of his life. The doctor’s assessment was not accurate; there are a number of new medications available for both non-metastatic and metastatic castration-resistant prostate cancer and the prediction that “nothing could be done” for this man was wrong. But worst of all, it had taken away the essence of the cancer experience for many—hope.

Hope comes in many forms. Hope can be positive when it buoys the spirit. Hope can be lost when reality reflects a poor outcome. False hope may reflect a distorted or inaccurate vision. Hope can take a long time to build and can be destroyed in an instant. Hope is something that we all hold onto as we strive to overcome barriers that prevent us from achieving our goals.

I did not try to excuse the physician’s inaccurate prognosis, and I repeated to Mr. G that we have medications that can prolong his life. I told Mr. G that I do not know what motivated the physician to say what he said, but I did know what the end result was, and I promised him that I would work very hard to help him regain the hope that had been taken from him. That work started by giving him the results of the hip X-ray: completely normal with no evidence of metastasis.

*Name and identifying details changed to protect patient privacy.

Anne Katz is a certified sexual counselor and a clinical nurse specialist at a large, regional cancer center in Canada who blogs at ASCO Connection, where this post originally appeared. She can be reached at her self-titled site, Dr. Anne Katz.

Image credit: Shutterstock.com

Prev

Speaking to cancer as if it were a person

January 2, 2020 Kevin 0
…
Next

Getting a terminal diagnosis for my baby

January 3, 2020 Kevin 5
…

Tagged as: Oncology/Hematology, Urology

Post navigation

< Previous Post
Speaking to cancer as if it were a person
Next Post >
Getting a terminal diagnosis for my baby

ADVERTISEMENT

More by Anne Katz, RN, PhD

  • Breast cancer’s silver lining

    Anne Katz, RN, PhD
  • Genital shrinkage is real. And so is the distress it causes.

    Anne Katz, RN, PhD
  • Do COVID restrictions in the office negatively affect patients?

    Anne Katz, RN, PhD

Related Posts

  • A physician’s addiction to social media

    Amanda Xi, MD
  • Why this physician teaches first-year medical students 

    Mark Kelley, MD
  • The pandemic has only further strengthened my passion to become a physician

    Karan Patel
  • Hormone replacement therapy is still linked to cancer

    Martha Rosenberg
  • How a physician keynote can highlight your conference

    Kevin Pho, MD
  • Chasing numbers contributes to physician burnout

    DrizzleMD

More in Conditions

  • Medicaid lags behind on Alzheimer’s blood test coverage

    Amanda Matter
  • Why transgender health care needs urgent reform and inclusive practices

    Angela Rodriguez, MD
  • Why the Sean Combs trial is a wake-up call for HIV prevention

    Catherine Diamond, MD
  • New surge in misleading ads about diabetes on social media poses a serious health risk

    Laura Syron
  • mRNA post vaccination syndrome: Is it real?

    Harry Oken, MD
  • The critical role of nurse practitioners in colorectal cancer screening

    Elisabeth Evans, FNP
  • Most Popular

  • Past Week

    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • How federal actions threaten vaccine policy and trust

      American College of Physicians | Conditions
    • What street medicine taught me about healing

      Alina Kang | Education
    • Are we repeating the statin playbook with lipoprotein(a)?

      Larry Kaskel, MD | Conditions
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Past 6 Months

    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • An addiction physician’s warning about America’s next public health crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gen Z’s DIY approach to health care

      Amanda Heidemann, MD | Education
    • What street medicine taught me about healing

      Alina Kang | Education
    • Smart asset protection strategies every doctor needs

      Paul Morton, CFP | Finance
    • The silent cost of choosing personalization over privacy in health care

      Dr. Giriraj Tosh Purohit | Tech
    • How IMGs can find purpose in clinical research [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • How federal actions threaten vaccine policy and trust

      American College of Physicians | Conditions
    • What street medicine taught me about healing

      Alina Kang | Education
    • Are we repeating the statin playbook with lipoprotein(a)?

      Larry Kaskel, MD | Conditions
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Past 6 Months

    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • An addiction physician’s warning about America’s next public health crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gen Z’s DIY approach to health care

      Amanda Heidemann, MD | Education
    • What street medicine taught me about healing

      Alina Kang | Education
    • Smart asset protection strategies every doctor needs

      Paul Morton, CFP | Finance
    • The silent cost of choosing personalization over privacy in health care

      Dr. Giriraj Tosh Purohit | Tech
    • How IMGs can find purpose in clinical research [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

A physician’s inaccurate cancer prognosis
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...