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Patient Patients

Harpham, Wendy S. MD

doi: 10.1097/01.COT.0000343806.22728.bf
View from the Other Side of the Stethoscope

The tests are done. I'm not going to “wait and see” but “live and see.” If I've learned anything, it's that I don't have to let fear steal otherwise good time while I'm waiting for test results. I've planned work projects and fun outings to keep me from sitting by the phone, wringing my hands.

The first few days I hardly worry at all. I may wonder occasionally if the radiology report has made it to my doctor's office yet. I may flush with a fleeting image of getting bad news. But I let these thoughts fly out of my mind as quickly as they fly in.

Another day passes. Soon I'll know whether I'm fine or if…no, I won't go there. I don't have a problem until they tell me I have a problem.

I envy my friend Nate, who remains calm while waiting for the results of a second biopsy after the first one was non-diagnostic. Retrieving Nate's email from earlier this week, I read it again:

“It is what it is. Nothing I think, feel, do or say can change the results. Worrying now won't make it any easier if I do get bad news. And I'll have wasted a perfectly good day worrying for nothing if it turns out the news is good. So I'm not worrying. I guess that makes me a patient patient! Ha, ha.”

All morning I try to be a patient patient. But by lunchtime, I'm picking up the receiver periodically to double-check the dial tone. Replacing my wall clock battery with a new one doesn't make the minute hand move any faster.

The squeaky wheel may get the grease, but I can't risk being a thorn in my doctor's side. I have an idea: If I don't hear from them in the next two hours, then I'll call. Five minutes later, I pick up the phone, dial my doctor's number and hang up.

I pick up my phone again and hit speed-dial 7. “Nate? How are you staying so calm? My head is starting to do crazy things, like…”

“Calm? I'm climbing the walls. Forget my last email. The longer I don't hear anything, the more convinced I am that I'm going to get bad news.”

“Nate, you told me, ‘No news is good news.’ You said if it's bad, they call right away. I mean, they'd want to move quickly if my scan is bad, right?” Suddenly I'm queasy with worries about my cancer growing while I'm sitting here twiddling my thumbs.

Nate responds, “All I know is that I almost bit off my sister's head for calling to see if I've heard anything.”

I smile. “When I was still pregnant after my due date with my first kid, people drove me nuts calling to see if I'd had the baby. For the entire nine months of my next pregnancy, I told everyone my due date was ten days later than the official date. Worked like a charm.”

“Sneaky,” Nate says with chuckle, “but good.”

Nate and I commiserate. The inconveniences and discomforts of the tests themselves are nothing compared to the waiting. Nighttime is the worst: In the dark and quiet, with our imaginations unleashed, any aches grow large. Talking helps me know I'm not the only patient unhinged by the helplessness of waiting.

My call-waiting signal interrupts us. “Nate, that might be him. I gotta go.”

(Quick deep breath) “Hello? Oh hi, doctor. Yes, this is a perfect time.”

This is not my story but a composite based on conversations with other survivors. For many patients, the lag between completing diagnostic tests and learning their results is a most stressful time. Prolonged waiting exacerbates survivors' sense of vulnerability and loss of control.

No physician or nurse can be everything to every patient all the time. Even in boutique practices, sick patients must take priority over call-backs. And ramping up to crisis mode all day is not an answer, either. You'd sacrifice the calming chitchat that enhances doctor-patient relationships and miss opportunities for healing your patients, not to mention you'd burn out quicker than birch wood on a fire.

Patients understand this. Yet patients still get upset or worry, often unnecessarily, while waiting. So here are a few suggestions to consider:

  • Assign a realistic call-back date. Be specific. And invite patients to call before that date if they want. The few who do call need your boost of support.
  • Quash unfounded fears up front with direct reassurances. For example, “One to two weeks will make no difference in your treatment choices or how you do.”
  • Offer uplifting mantras, such as those italicized above. Recognize that such self-talk and positive thinking can hold off the demons only so long.
  • Offer short-term anxiolytics and/or sedative hypnotics as a backup, if appropriate. Many patients benefit from a prescription, even if it remains unfilled—or filled but unopened—on their nightstand.
  • When calling with test results, thank your patients for waiting and apologize for undue delays.

Tick tock. Tick tock. Waiting for test results can be trying. When it isn't possible or reasonable to review test results soon, you help your patients by guiding and supporting them through the waiting.

© 2008 Lippincott Williams & Wilkins, Inc.
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