Clinic Speak: getting it wrong

Getting it right when giving the diagnosis of MS. #ClinicSpeak #MSBlog #MSResearch

"On Tuesday I got it wrong and need to apologise. I work in a teaching hospital and tend to have several medical students or visiting fellows in my consultation room at any one time. In addition to the medical students I supervise at least two other doctors who have separate consulting rooms. Hence, I am in and out of my room and people come and go during consultations. On this particular occasion I was giving someone the diagnosis of MS and was disturbed three times during the consultation. Although this particular patient was expecting the diagnosis - she had previously been diagnosed as having CIS - she was still very upset and simply needed my undivided attention and not divided attention. On reflection her experience of this consultation must have been terrible. What prompted me to write this post is the very sensitive and moving article below that I read on the Tube going to work yesterday. Although it was about dying with dignity in ITU it covered several issues about compassionate care; reading it made me realise that I have to improve the way I deliver care in my current working environment. What this blog, and interacting with MSers outside of clinical practice, has taught me is how poor neurologists are in general, in giving MSers the diagnosis of MS; me included."

"Several of the points in the table below summarise what compassionate care is all about and is not only relevant to the dying patient, but to someone who is being told that they have MS or any other life-changing diagnosis." 

Cook & Rocker. Dying with Dignity in the Intensive Care Unit. N Engl J Med 2014;370:2506-14.

Examples of the ABCDs of Dignity-Conserving Care.*

Attitudes and assumptions can affect practice.


Behaviors should always enhance patient dignity.


Compassion is sensitivity to the suffering of another and the desire to relieve it.


Dialogue should acknowledge personhood beyond the illness.

* Adpated from Chochinov HM. Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. BMJ. 2007 Jul 28;335(7612):184-7.

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