1. TALKING TO THE PATIENT AND FAMILY!

2. While talking to the patient and their family… *Sit down and make eye contact with the patient and their family.

3. I am Dr._ Name__. I am a _ Kind of Dr._. I am on the __ which_service ___ and I have been asked to do a __ type of test __. I wanted to come by and explain the __test __ to you. Who am I ?

4. I am here today to explain to you and your family: 1- what the procedure is 2- what the procedure isn’t and basically try to answer any questions you have. Why?

5. Review the journey Just to review how things have gotten to this point, let me tell you my understanding of how we have gotten here and you correct me anywhere that is different from what you know. You have now engaged the patient and assured him/her that you understand the problem. He is listening to what you are saying and now feels that he is being talked with instead to talked at.

6. Basically when you went to _Dr. name___ for _reason___ a _ kind of test __ was done along with other studies. The _test__ showed an area of_ concern__ in the ___body part__ that looked questionable / changed from __previous exam. IF NO PRIOR EXAMS JUST SAY QUESTIONABLE We now need to do another exam to determine if that region is truly normal or a significant problem. That is what we are going to do with the _ kind of test_. If it shows something at that area, it can tell us it is abnormal but usually can’t tell us exactly what is causing it. It can tell us there are several possibilities and probabilities. So the first goal of the _ kind of test__ is to determine if this area is real or significant and what it most likely is.. Discussion of exam

7. Discussion of Exam The problem is that we can’t base a plan on something possibly being this or that…. I think right now the possibilities are: 1- an area of scarring 2- a region of infection 3- a type of tumor Our plan of action will be different depending on what the area of concern turns out to be.

8. Options The options that we have now regarding what to do are: 1-- Observation 2-- Surgery 3-- Biopsy

9. Discussion of Options One of your options would be to get a follow up study after a few months and see if the area changes. If it doesn’t change or gets smaller it is likely a scar and is best left alone. The problem with this option is that if the area gets bigger we have lost some time that we could have started treatment. This is still a reasonable plan but this option requires time to see if it is the best plan. Observation

10. Discussion of Options Surgery A second option would be surgery. We can take it out, find out what really it is and hopefully treat it at the same time and be done with it. The problem with this option is that all things don’t need to go to surgery. There is a risk of surgery and the time for recovery may have complications. Again we solve the problem but we may find that you really didn’t need the surgery anyway.

11. A biopsy is what we have been asked to do and it is some what of a middle ground that tries to tilt the scale one way or the other to determine if something is a scar and better left alone or a tumor and best to go to surgery. The way it works is using the _ type of machine __ for guidance the area is located and a _ small needle_ is directed into the area and a sample of the tissue is taken through the needle. Discussion of Options Biopsy

12. Discussion of Options Biopsy We take a sample of tissue and let the pathologist look at it under the microscope and basically tell us what is or what it is most typical for. The biopsy can try to answer the question without having to go to surgery and would have less overall risk than surgery.

13. Discussion of Options Biopsy The advantage is it does not require stitches or an incision. The disadvantage is it doesn’t take a large sample and sometimes we can not get enough tissue in the needle to answer the question. There is a risk of bleeding with any procedure using a needle But the small size of the needle limits this. We are doing this _ test_ in a hospital and have the people here to take care of any problems.

14. I’m sure this is a world wind of information for you and I will be glad to go over again any of it that was not clear. Questions?