Sunday, February 26, 2012

Poker Face

"Doc, how'd it go?"

That's one of the most common things a patient says when he wakes up from surgery. Usually it's a no brainer. You can happily tell the patient his appendix has been removed. Or his hernia is now repaired. In other words, things went as predicted and everybody can live happily ever after.

But sometimes the surgery doesn't go as planned. Maybe the arterial revascularization was not successful and now the patient faces an amputation of a limb. Or the surgeon opened up the abdomen and discovers an unsuspected Stage IV malignancy. Now what do I tell the patient, if anything?

As decent members of society and also as physicians, we have been taught not to lie. It was ingrained in us as children when we learned about George Washington's inability to tell a fib to his father after he chopped down a cherry tree. In medical training, if we told a lie about a patient's history or how we cared for a patient, we were usually discovered quickly and shamed in front of the whole group during rounds. Lying about a patient is simply not tolerated, as it shouldn't be. Therefore when a patient asks how an operation went, it presents a severe moral dilemma. Should I lie to the patient and let the surgeon break the bad news? Or should I inform the patient about some general details and have the surgeon give the specifics of the case?

I usually opt for the former and pretend that everything was fine. But I have a terrible poker face. Patients are usually perceptive enough to know that something is not right. They may start asking me or the OR nurse for more details as the surgeon is usually out of the room by the time they are awake. We all try to put on our game faces but they are not fooled. The more I tell patients the surgeon will come soon to tell them the details, the more frightened they become. They know I'm holding back and that it cannot be good news. Yet if I reveal what happened during the operating, I don't feel I can be the one to give the patient more information about follow up procedures and plans that may alleviate the patient's anxiety over the findings.

What would George Washington do in this situation?

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