Physicians don’t take the diagnosis of cancer lightly. In the usual case, thorough investigations are done – blood tests, scans, biopsies, etc. before the diagnosis is made. This is so that subsequent treatment can be planned and optimized for the patient. However, this is not always possible for home care patients, nor is it always necessary.
Two recent patients come to mind.The first patient was in her mid-nineties with a breast lump and enlarged liver – found by examining the patient. She was referred to hospice care and passed away within 3 months. The second patient (also about ninety years old) had a growing patch of discoloration in her mouth (previously biopsied 1 year ago and told no cancer). Similarly, no further investigation was made and she received palliative care at home before passing away in a matter of months.
These patients certainly did not want further investigations to confirm the diagnosis – it was enough to have examined the patient. In fact, home clinical assessment and close follow-up was able to provide a more accurate picture of the second patient’s condition. Neither did they need a hard ‘technical’ diagnosis to guide further treatment – they had wanted to remain comfortable and receive palliative care at home.
In the past when hospital based care was more visible than home care, this way of managing patients (without a ‘hard’ diagnosis) might have been perceived as inappropriate or less than a reasonable standard. Some physicians may have felt uncomfortable about not having a firm diagnosis in these cases.
But this is all a matter of context. It is about understanding the patient’s situation and needs, rather than having to fulfill technical or organizational needs (and definitions). Going back to basics – hands on examination of patients – may be just the thing that is needed and that provides patients the feeling that they are cared for.
The Housecall GP 