In her late 50s, Cathy developed fatigue. Over the course of a few months, she began to take afternoon naps and fall asleep earlier than normal. Then, over a 2-week period, she gained 15 pounds. Overnight, her belly swelled full of fluid, and she appeared 7 months pregnant. The next day, Cathy's primary care physician sent her to the hospital emergency department for a CT scan of her abdomen and pelvis. As a physician myself seeing patients at another nearby hospital, I logged into the network computer and, with Cathy’s permission, reviewed her scan results with the emergency department physician over the phone. Cathy's imaging and subsequent peritoneal fluid were consistent with advanced ovarian cancer—to me, a death sentence. I had delivered poor prognoses many times during my career, so I took it upon myself to give Cathy the bad news and ensure that I would be with her during this difficult conversation. This was especially challenging because Cathy was no ordinary patient—she was my wife of 31 years.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Wice MB. A Difficult Conversation. JAMA. 2019;322(8):727–728. doi:https://doi.org/10.1001/jama.2019.11757
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: