Indexing Title: ROJOSON’s Medical Anecdotal Report [06-01] 

MAR Title: There is Risk in Being Compassionate 

Date of Observation: March, 2006 

Narration: 

A 46-year-old Filipino female came to see me in Manila for a breast mass with a mind-set that she needed to undergo an operation as soon as possible.  She came all the way from a distant province in the north.  She discovered a right breast mass 4 months prior to consulting me.  She had consulted several physicians before, given antibiotics, analgesics, and various advices, mostly towards a cancer diagnosis and an operative treatment.  She came to see me because of a referral from a radiologist-friend of mine and who was a distant relative of hers.  After I examined here, my finding showed a 7-cm right breast mass, well-defined, non-tender, movable, not hard in consistency, questionable nature but more on the cystic side, with no palpable axillary lymph node. My primary clinical diagnosis then was a macrocyst and my secondary diagnosis was a breast cancer.  I gave her a 70% degree of certainty for my primary clinical diagnosis.  Because of the uncertainty of the diagnosis and because of the probability of a macrocyst, I recommended a needle evaluation right there and then in my office.  Because of her mind-set to have an operation, she initially was hesitant to follow my recommendation and would rather have an outright operation to remove the mass including her breast, if necessary.  After an hour of discussion and difficult convincing, she consented to the needle evaluation.  After the procedure, she went home very grateful with a mass that completely disappeared and with no need to undergo an operation after all.

INSIGHT: (Discovery, Stimulus, Reinforcements) (Physical, Psychosocial, Ethical)

 When I was informing and convincing her of my working diagnosis and recommendation, just as she was anxious of what she would undergo, I was also anxious of what I was recommending.  What if, in the end, after the needle evaluation, she would undergo an operation just the same.  With a mindset that she needed to undergo an operation, I could imagine her saying to me, “I told you so.”  The sense of compassion in me and mindful of values of integrity and honesty, however, prevailed over an easy solution to the impasse and bigger professional fee.  I could easily give in and let her have her way to have an outright operation with a bigger professional fee compared to the one that would charge for a needle evaluation.

 In the practice of medicine, challenges and balancing acts in decision-making abound.  The weighing of the benefit-risk ratio is the generic balancing act that physicians do and are familiar with.  It usually involves weighing the benefit-risk ratio in selecting treatment and paraclinical diagnostic procedures.  This anecdotal report shows that the balancing act includes practically all aspects of the physician-patient relationships, including giving advice and being compassionate, as illustrated in this particular anecdote.