The ACR Code of Ethics also states, “Members shall not dispense or supply drugs, remedies, or appliances unless it is in the best interest of their patients.”3 Therefore, if our best judgment dictates an ongoing treatment plan is not beneficial for the patient, then our moral duty is to make appropriate changes promptly, whether or not that medication is benign.
Seemingly at odds with this imperative is the desire to maintain our patient’s trust. That trust may be bolstered, however, if we begin our conversation with patients by trying to understand the psychological and physical journey the patient took following the diagnosis of a chronic medical condition. Elisabeth KÜbler-Ross identified five stages of grief: denial, anger, bargaining, depression and acceptance; patients with chronic medical illnesses often experience similar reactions after learning about their diagnoses.4 Psychological reactions to receiving a diagnosis are unique to each patient and evolve over time. Because patients develop coping mechanisms for their diagnoses, we must also understand how they coped with a diagnosis if we are to help a patient effectively. It is not only their diagnosis that is changing. Their lives may change tremendously.
If our best judgment dictates the ongoing treatment plan is not beneficial for the patient, then it is our moral duty to make appropriate changes promptly.
Additional nuances can complicate the situation. This conversation may take place during an initial visit, when the physician-patient relationship is not well established and the physician has not yet earned the patient’s trust. In addition, the physician may not have full access to the patient’s past records and could be missing a crucial piece of information that led to a prior diagnosis. Establishing a deeper relationship with patients and ensuring the full picture of their care is obtained is essential prior to making such a crucial decision. Taking the extra step of communicating with the previous medical provider, which should be integral in the transition of care, can help elucidate any confusion regarding past history or why the diagnosis was made in the first place.
The predicament of having to change a diagnosis altogether could perhaps be avoided if a well-informed diagnosis is made in the initial patient encounters. Following the guidelines employed by physicians discussing a cancer diagnosis—using simpler language, allowing adequate time for discussion in an appropriate clinical setting, understanding the patient’s mental state at the time and using such words as “suspicion” or “possibility” of a disease until a definitive diagnosis is made—could prevent a premature or incorrect diagnosis.5
