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Ethics & Law · patient case question

The histopathology report confirms squamous cell carcinoma. How should the result be conveyed to the patient?

Patient case: Suspicious lateral tongue lesion in a long-term smoker

Patient: Male, 63 years old

Chief Complaint: “There is a rough patch on the side of my tongue that will not go away.”

Background: Forty pack-year smoker, daily alcohol. Present for four months, not resolving after removal of a sharp cusp.

Vital Signs: BP 142/88 mmHg · HR 80 bpm

Findings: A 2 cm indurated, mixed red-and-white lesion of the right lateral tongue with an irregular surface. Non-tender. No palpable cervical nodes.

  1. Wait and let the specialist to whom he is referred deliver the diagnosis
  2. Schedule an in-person appointment and deliver the result face to face, with the referral pathway arranged
  3. Send the result through the practice's social media or patient messaging account
  4. Telephone him with the result as soon as it arrives, so he is not kept waiting
Show answer and explanation

Correct answer: B. Schedule an in-person appointment and deliver the result face to face, with the referral pathway arranged

  • A. Deferring entirely to the specialist abandons the duty of the clinician who ordered the biopsy. It also delays care and leaves the patient uninformed during the interval.
  • B. CORRECT. Serious diagnoses are delivered IN PERSON, in a private setting, with adequate time, ideally with a support person present, and with the next step already arranged so the patient leaves with a plan rather than only with news. The structured approach taught for this is SPIKES: Setting, Perception, Invitation, Knowledge, Empathy, Strategy and summary.
  • C. Any electronic messaging channel is inappropriate for a malignant diagnosis on both confidentiality and humanity grounds. Social media in particular offers no assurance the message reaches the patient rather than a family member.
  • D. A telephone call gives speed but nothing else. The patient receives life-altering news alone, with no support present, no ability for the clinician to read distress and respond, and no immediate answer to the questions that follow. Telephone is acceptable for benign results, not for this.

Note: Deliver the result yourself, in person, and have the referral in hand. The patient's first question is almost always 'what happens next' — being able to answer it is part of delivering the news well.

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