Real-Life Decision Making -- Solution
You try to persuade Mr. Clark to have the surgery.
Mr. Clark is very uncomfortable with traditional Western medicine and prefers to treat himself with alternative techniques. He has asked you to continue giving him drugs to relieve his symptoms, but that is all.
You have had experience with this kind of patient before and it did not turn out well. You decide to go at Mr. Clark with every scary statistic and story you can muster. You feel that you must convince him to go forward with the surgery. It will probably save his life.
You keep after Mr. Clark with as much information as possible. You know that some doctors would fault you for not respecting your patient's wishes, but you are willing to take this risk. You even have Mr. Clark speak with a group of testicular cancer survivors who help to convince him to be more aggressive in his treatment.
Finally, Mr. Clark agrees to have his testicle removed so that a biopsy can be performed. You can see that he is still not happy with the whole procedure and you worry what will happen if he does not have cancer -- will he sue you and the hospital for forcing the biopsy on him? Ultimately, you trust your judgment.
The biopsy does show cancer, and other tests show it has spread. Mr. Clark now seems relieved that he went through with the surgery. He also agrees to have nearby abdominal lymph nodes removed since the cancer has spread to them. This usually is enough to cure limited testicular cancer.
Mr. Clark must return to see you for frequent checkups to make sure the cancer is truly in remission. He does and remains cancer free. You are very happy that you decided to be aggressive with such a young patient.
"You see someone who is young and grief-stricken because they have the diagnosis of cancer, and cancer is such a terrible thing to have....Whenever anyone hears the word cancer, they think death and that's not necessarily so," says urologist Joanna Chon.
"Then you go and take out the kidney or the prostate and the patient is cured, and he will live the rest of his life normally and die in old age of other things. Then when you check up on them later and there's no recurrence of cancer, it's just a wonderful feeling!"