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Dr K K Aggarwal

Never tell a patient that you are suspecting a diagnosis of cancer

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Informed consent and a premature communication can be dangerous. Communicate the diagnosis only after it is confirmed that too if it is necessary.

Suspicions of a cancer or any serious illness should not be communicated unless it is confirmed as it can cause more harm and the harms can persist for years, added Dr S Arulrhaj Past President Commonwealth Medical Association.

A prospective cohort study reveals that negative psychological consequences of false-positive findings on screening mammography may persist for at least 3 years after the initial diagnosis. Women with false-positive findings had similar psychosocial outcomes to those diagnosed with breast cancer at 6 months in the study. At 6 months, psychological testing showed that women who received false-positive results remained as upset as women who had breast cancer.

Three years after the false mammography results, women still exhibited greater psychosocial consequences compared with women who had normal mammograms Dr John Brodersen and Dr Volkert Dirk Siersma, PhD, of the University of Copenhagenin Denmark wrote in an article published in Annals of Family Medicine.

The reported frequency of false-positive mammography results ranges from 20% to 60% in the U.S.and Europe, said Dr Anita Kant Senior Gynecologist at Faridabad.

  

1. Look for coexisting medical condition, psychiatric disorder, neurologic disease, sleep disorder or drug associated with insomnia.

2. Insomnia that last less than three months: acute insomnia, circadian rhythm sleep disorders (jet lag, shift work), and high altitude insomnia.

  1. Insomnia that last longer than one month: include inadequate sleep hygiene, psycho-physiological insomnia, idiopathic insomnia, behavioral insomnia of childhood, paradoxical insomnia, and insomnia associated with a variety of medical conditions, psychiatric disorders, neurologic diseases, sleep disorders, medications, or drugs.

Acute insomnia

a.     Acute insomnia lasts for less than three months

b.    Is temporally related to an identifiable stressor

c.     Synonyms for acute insomnia include adjustment insomnia, short-term insomnia, stress-related insomnia, and transient insomnia.

d.    Resolve when the stressor resolves or when the individual adapts to it.

e.     Stressors can be physical, psychological, psychosocial, interpersonal, or environmental:

f.     Stressor as mentioned in Vidur Niti: A thief, A lustful person, A person who has lost all his wealth, A person who has failed to achieve success, A person who is weak and has been attacked by a strong person.

g.    Ayurveda describes sleep as an aggravation of Vata. The causes are mental tension; suppressed feelings & acute bitterness.

h.     Other stressors :  Changes in the type or level of background noise; changes in the bedroom, such as a different bed or different furnishings, lighting, temperature, or occupants; consumption of or withdrawal from caffeine, nicotine, alcohol, or foods or beverages that contain these substances; stressful life events, such as loss of a loved one, divorce, loss of employment, arguments, particularly happy or sad events, work demands, or school demands; acute or chronic injuries or illnesses, particularly those causing pain or discomfort; medications or illicit drugs that have stimulant properties such as  theophylline, beta blockers, steroids, thyroxine, bronchodilators, or amphetamines, withdrawal from central nervous system depressant drugs and nursing home or hospital admission.

i.       Stress-induced insomnia is related to increased activation of arousal systems rather than decreased drive for sleep.