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HE BAD NEWS AND THE BAD NEWS
1. Read the text and discuss what the 'good news' was for the
patient.
I recently saw a 64-year-old man with a skin lesion on his knee
that had been intermittently weeping pus over the past four weeks and
had been growing in size. The lesion was well demarcated, granulom-
atous, and about 2x2 cm in size. He had had it for over a year, but it
had never bothered him until recently. The lesion did not look infect-
ed, so I decided to remove it and send it for histology.
Four days later, I was called by a consultant pathologist, who
started quizzing me about this patient. Specifically he wanted to know
the patient's sexual orientation and whether he was an intravenous
drug user. The patient was homosexual, and when I told the consultant
so it seemed to confirm his suspicion. 'This looks like a nodular Kapo-
si's sarcoma,' he said, 'but I'll need to send it to an expert in London to
confirm this as I'm really not certain
From what I knew about Kaposi's sarcoma, it was nearly always
linked to HIV infection. I feLt apprehensive about telling the patient
of the diagnosis for several reasons: I still had no definite confirma-
tion that this was Kaposi's sarcoma (the Londo.n expert would have
the final word on that) and I would have to tell the patient he had a
cancer and very possibly HIV infection as well. Talk about breaking
bad news. I therefore decided not to tell the patient until I had the ex-
pert opinion.
I finally heard back from the consultant in London: Yes, this has
all the features of Kaposi's sarcoma.' I called the patient in and broke
the bad news to him. I told him that there was a good chance that this
form of cancer was linked with being HIV positive, and he understood
this. He explained that he had always avoided the issue of HIV testing
because he was frightened. He was understandably shaken.
In our surgery we put alerts on the patient's computer records and
had patient". I talked to the regional genito-urinary medicine clinic,
where the patient was seen the next day.In our surgery we put alerts
on the patient's computer records and had a "critical event" meeting to
alert all staff about the "high risk