Who you are:
You are an FY2 in the Surgery department.Who the patient is:
Remy Adams, 32 years old.Other information:
She had a FNAC following an abnormal mammogram result done as part of her routine breast screening. The FNAC was done in an outdoor clinic a few days ago. The test shows that she has low grade DCIS.What your task is:
Talk to the patient and address her concerns.
Patient information:
You are Remy Adams, 35 years old
You had a test done few days ago. The nurse at the outdoor clinic explained to you that there is a possibility of breast cancer being detected in this test.
You are very anxious about the results.
You regularly self-examine for breast lumps.
You do not smoke, or drink. You get regular periods. Your first period was when you were 14.
You have read on the Internet that your breast can be removed.
You do not understand how you could’ve got this.
QUESTIONS:
What will you do for me?
Why do I have this?
Will you remove my entire breast? I read on the internet about lumpectomy.
Doctor: Hello, I am Dr (name), one of the junior doctors working in the Surgery department. Can I confirm your name and age please?
Patient: Hello doctor, I am Remy Adams, and I am 35.
D: Is it okay if I call you Remy?
P: Yes that’s fine.
D: Nice to meet you Remy, I can see from my notes that you have come for your FNAC results. Is it okay if I ask you a few questions before I explain your results to you?
P: Yes doctor, go ahead.
D: Thank you. So can you walk me through what happened and why you had the FNAC done in the first place?
P: Yes doctor. I underwent my Mammogram a few weeks ago as a part of a routine breast screening program. The results came out abnormal. The FNAC was taken in the clinic. Honestly, I don’t even see why I would have an abnormal mammogram result as I have a very healthy lifestyle. I even examine myself regularly for any lumps. I am really scared about this result doctor.
D: Firstly Remy, I think it is great that you put in the effort to stay healthy, and I applaud that you self-examine on a regular basis. I can see you are really concerned about the results, but in order to answer your queries in a better way, I will need to ask just a few more questions. Is that ok?
P: Yes doctor.
D: Do you have any pain at the site of the procedure?
P: No doctor.
D: Remy, you did say that you regularly examined your breasts. Did you by any chance feel any lumps?
P: No doctor.
D: Any discharge from your nipples?
P: No doctor.
D: Any changes in the skin of your breast or nipples?
P: No doctor.
D: Have you noticed that you have been eating less than usual by any chance?
P: No doctor.
D: That’s good. Have you been noticing any unintentional weight loss?
P: No doctor.
D: Any fever at all in the past few days?
P: No doctor.
D: Any night sweats?
P: No doctor.
D: Any lumps and bumps elsewhere on your body?
P: No doctor.
D: Remy, can you tell me if your period is regular?
P: Yes doctor. My last period was last week.
D: And can you tell me when you first got your period?
P: It was when I was 14, doctor.
D: Do you smoke or drink?
P: No doctor.
D: Does anyone in your family have a history of cancer?
P: No doctor.
D: Were you diagnosed with any medical conditions in the past?
P: No doctor.
BBN- Assess knowledge, Warning shots and give the diagnosis. Pick on any non-verbal cues on revealing diagnosis, and acknowledge them. For example, being taken aback, disappointed.
D: Alright Remy, thank you for being patient with me. Let us discuss your test results now.
D: Do you have any idea of what the result might be?
P: Yes doctor. The nurse at the clinic did explain to me that there is a possibility of cancer.
D: Remy, before I talk to you about the result, is there anyone else you would like with you here today?
P: No doctor. That’s okay.
D: Alright Remy, I’m afraid the results of your FNAC do show some abnormal cells in it. In medical terms, we call it ductal carcinoma in situ. Have you heard of it?
P: No doctor. Is it cancer?
D: Ductal carcinoma in situ is a very low grade of breast cancer, which means that it has not spread to the nearby tissue. The good news is that since we caught it early, it is a very treatable condition.
P: Why did I get it doctor?
D: There are various risk factors that might cause this but in your case, it’s not clear why you got it.
P: What can you do for me doctor?
D: We have various options to treat you at this point. The first option is Surgery.
P: Are you going to remove my whole breast doctor? I read on the internet about options like lumpectomy.
D: That’s great that you have been reading about it. You are right. There are two options when it comes to removing the cancerous cells. We could either remove your entire breast, also called a mastectomy, or remove only a part of the breast that has cancerous cells in it, also called a lumpectomy. Is there anything that particularly concerns you about these options?
P: Yes doctor. I would rather not have my breast completely removed, as it affects the way I look, and I feel like I will really lose my confidence after that.
D: Remy, your concern is valid. I will make sure I discuss with the senior surgeon about the best option in your case, and request him to have a chat with you about it as well. Apart from the surgical options, the specialist may also offer you with the option of hormonal therapy. Your breast can be reconstructed following the surgery, and we can make sure the way you look isn’t affected.
P: Okay.
D: Is there any other concern that you would like me to address?
P: No doctor.
D: We will be arranging for you to see the breast surgeon urgently, within two weeks.
P: Ok.
Safety net for FLAWS and metastasis. Offer leaflets.