I stepped into an exam room the other day and saw a 3-year-old who was in the office for a hospital follow-up. She'd been admitted for cervical adenitis and had spent 3 days on IV antibiotics. The node had decreased in size and she had been discharged with oral antibiotics. She felt well, was afebrile, and had a 2-cm nontender node at the angle of the jaw on the left side.
I told her mother that the cultures were negative and that it might take a month or even longer for the node to completely disappear. Throughout the history taking and the examination, I thought the mother appeared tense and anxious. After seeing that my reassurance was not helping, it seemed necessary to ask what, if anything, was worrying her.
She told me that the doctor in the emergency department who admitted her daughter told her that the problem "could be cancer."
Granted, malignancy can enter the differential diagnosis of nearly everything. And one should be cautious in accepting a patient's account of what another doctor is supposed to have said.
But what if what this mother described had actually happened? What if the parent of a child with a run-of-the-mill pediatric problem was presented with a potential nightmare scenario--and for no good reason?
It is not good to think aloud in front of parents. It is not good to unthinkingly toss off possibilities that need to be proved before they should be discussed.
We, as physicians, complain about patients not following our advice and not listening to us. We should not forget that they are listening, that our words are not ignored, and that therefore, they should be well chosen.