I’m writing this article as a reflection of my time as a medical student. Weekly, I saw patients receive a diagnosis of breast cancer. To respect patient confidentiality, I will obscure many details and leave out where and when these experiences occurred. I hope that this piece gives an insight (from a medical student’s perspective) into how people receive a cancer diagnosis.
I reflect on how the diagnosis is actually delivered, and patients’ responses. What do people do and say when they hear the words? Quickly, I learned that there isn’t a normal response. There’s not a one-size-fits-all method of delivery, either.
Before the consultation
I found myself intrigued by each person’s story. Where was life taking them before they arrived at the clinic today? I thought it would be useful to know the details of their cancer too – but as a medical student it was rarely called upon. Of course, it was useful for the impromptu quizzes hosted by the breast surgeon I was shadowing. (They were the sort that sometimes resembled more an ambush of trivia than a question in passing – but I’ve had worse!)
In reality, whilst I desperately listened to the surgeon as they brought me up to speed on a patient’s case, I realised what awaited. For me, this was just another day. My placement lasted a year and it just became part of my routine. I had fun plans for the weekend and a wishful dream of catching up on study. That’s where my life was taking me.
It dawned on me that my patients had everything planned too. Coffee with friends. Work. Raising their kids. They were in control of their lives. Everything seemed predictable and certain up until they entered the consultation room, or answered the phone call (COVID!), that is. Despite this, I was nervous. Should I smile? Ask how their day’s going? Do I know where the tissues are? I was awkward. Nothing had even been said yet.
Entering the room
People were called from the waiting room to meet their surgeon in a private room. I had placed a chair in the corner – out of the way – for myself. The breast surgeon, my mentor for the year, had an incredible skill at just being friendly. They built a fantastic rapport with all patients and, if I’m honest, they put me at ease. So, I figure they must do wonders for patients’ anxiety too.
Together, my mentor and a breast care nurse would walk the patient through the “what’s happened so far”. They discussed what the patient found (If anything) on day one, the tests and results they’ve had since then, before discussing the “today”. Does this person have cancer?
I initially thought that “cancer” was a yes or no situation. But, and I won’t go into detail, there are some cases where it’s not as clean cut. Either there isn’t enough information to make a conclusion, or the conclusion is that the patient has a type of change that, whilst abnormal, isn’t technically considered cancer. Alternatively, the news the patient is about to receive could be just that.
Receiving a cancer diagnosis
“Your scan suggested a mass in place X. We took a sample and the report is back. Our findings suggest that you have c-.”
I watched many patients hear this conversation exactly as it’s written. Broken. Some people will cry there and then, in the car, the next day, or – not at all. A GP once told me to be cautious when instinctively reaching for tissues because somebody is crying.
Are you sure you’re offering a tissue to help them keep their make-up? Or are you doing it because society feels uncomfortable seeing someone cry, as if it needs fixing?
An interesting thought, and one that chimed here. I made sure that the tissues were at least within an arm’s reach, and the patient and I tuned back into the consultation.
Medical school says that, after the “c” word, patients will struggle to hear anything thereafter. And, whilst that’s sometimes true, it’s not always. Patients will want to know different amounts of information. I learned that it’s important to recognise this. Offering the details of the cancer, the prognosis, the treatment plan, the contact details, the “if this, then that”. Minds can derail a little after the “c-“. For some, though, it could be helpful – expected, in fact. So, it’s important that clinicians can mould to this, and vary the amount given on a patient-by-patient basis.
Still sat in the corner of the room, I realise that there is no “expected” response for somebody receiving a diagnosis of cancer. Some people do cry and some appreciate a tissue when offered. Others simply nod. A few have smiled, as if they knew all along. The one thing that they do all mention? The people that they’re close to. I had always thought that a patient would be more worried about their own health, than how to tell their loved ones. But, I witnessed incredible selflessness. And I’ll never forget that.
There’s a spectrum of responses and as a human, we can match all of them with compassion. I learned to introduce myself to patients with a smile and to encourage small talk. Ask about the weather, maybe about their day, if it seems right. Encourage questions and offer as much, or as little, support as they need.
There are no clichés.