The Confusion: How to Interpret Doctor Speech


Doctors Are Confusing.

The bad news I received on Monday does not feel as end-of-the-world today. I went to my new endocrinologist on Tuesday and my husband and I spent a cautious hour and a half asking questions so that there will be no more future confusion.

If you read my “Bad Day” post, you may have picked up on the fact that, up until Monday, I was under the mistaken impression that, not only had my surgery been a success in the sense that I survived, but an awesome success in the sense that they removed all the cancerous tissues and that these were strictly limited to the tumors on my thyroid. This is not the case. The reality is:

• Instead of two smaller tumors/nodules on my thyroid, I had one large tumor, approximately 3 cm in size. How I managed to miss this is beyond me. How my PCP managed to miss this when we were specifically checking for thyroid problems 6 months prior to my diagnosis makes me think I need a new PCP. According to doctors throughout this process, it is better to have multiple nodules than a single nodule, because this likely means a larger nodule is dominant rather than cancerous. This was, of course, told to me as a piece of hope during a time when I was supposed to have multiple nodules. More than 10 medical professionals had examined me before it was determined that I had a single tumor. I guess the lesson here is to not take your doctor's word for it, but double and triple check their assertions.

• Instead of having the cancer limited to my thyroid, the cancer metastasized to nine surrounding lymph nodes. Nine out of nine (apparently everyone has a different number of lymph nodes). Not a good one in the bunch. However, this does not, ostensibly, mean I am more likely to die. I have the same prognosis as before. What it does mean is that I have a higher chance of recurrence (scary) and have to take small radiation doses for yearly scans (scarier) and be on this stupid low-iodine diet for at least two weeks of every year (ugh). I’m rapidly coming to the conclusion that the worst thing about thyroid cancer is that you can never truly be cancer-free. Even if all thyroid tissues are successfully eliminated, even if I never actually have a recurrence, the scans, blood tests, diet, synthroid dependence, scar, are all for the rest of my life. There is a decided loss of freedom in that.

Like me, you may be wondering how the heck I ended up so confused about my diagnosis. How did it get to the point where not a single member of my family understood my status or prognosis, except my mother-in-law, the doctor?

I have a theory. Remember how I found out about my cancer at work? Because the phone message I had received from Dr. K was so darn chipper sounding? Same principle at work here. I am dubbing this the Medical Professional Tonal and Terminological Irony Theory©.

Medical professionals must and will give bad news. They will potentially do so multiple times a day, every day, for the rest of their professional careers. Nobody likes giving bad news. Once upon a time, bad-news messengers actually got killed for delivering their bad news. That’s how the phrase came about.

So doctors, being as smart as they are, have come up with a fool-proof system for delivering bad news: do so in the most positive tone of voice possible, using the cheeriest terms you can think of. Perhaps you have already considered the medical “positive v. negative” conundrum. How in any other situation, they have a single, given denotation, as elucidated in dictionaries and first-grade classrooms everywhere. But in medical situations, presto! The meanings switch! Positive now means you have contracted some horrible, possibly fatal illness and negative means you are going to be just fine.

Add to that a giant smile, a delivery of large vocabulary statedinanextremelyfastsideeffectsanddisclaimersmanner and a honey-molasses tone and the patients are instantly fooled. Not a clue as to what is really going on. The end result looks something like this:

So while I was in my post-op, drug-hazed, state of mind listening to my peppy surgeon talk about how positive everything was, I managed to misinterpret my state of health as being hunky-dory.

If  You Have Questions About Your Diagnosis, Ask Them!

Lessons learned:
• Be wary of smiling, cheerful-sounding doctors
• Always anticipate bad news (can’t be disappointed)
• If you don’t understand something, ask. Then ask three more times and get a printed copy.
• Don’t be afraid to ask doctors to slow down when speaking.
• Don’t try to understand things when on heavy pain meds. Have someone else with you to do the understanding (preferably a sober adult).
• When it comes to your health, positive is not.
• Do not get distracted by singing and dancing barbershop quartets.

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