Priorities, Doc

My preceptor and I were reading through a patient's history yesterday. This is fairly standard procedure before giving chemo - we want to know a bit about the patient so we know we're giving the appropriate treatment, what questions to ask and to get an overall picture of the person. The Medical Oncologists dictate their notes, so at least they're legible - the down side of this practice is that on the day of treatment there is nothing written, often leaving us going "what the hell is going on?"

But I digress... We were reading a fairly extensive summary of past history and the current investigation (current meaning 2008 when it was found) for suspected bowel cancer. Lots of medical jargon and an entire typed page later, the patient has fairly nasty colon cancer. That sucks. Treatment plan listed, thanks for referring, blah blah blah... My preceptor and I are about to skip ahead a bit when I notice the single line PS at the top of the next page:

PS - CT scan shows liver metastasis.

What??? Uh, a spread of cancer to the liver is pretty fucking serious. In fact, it renders the cancer incurable. And you mention it as a post script???

We shake our heads and skip ahead. The patient has done remarkably well and is still with us a year+ after her diagnosis. This does not mean her cancer is cured or the doctors were wrong... it means it hasn't spread further and she continues with active treatment to continue to prolong her life. Just so we're clear. We then find this sentence opening a recent progress note:

She has recently returned from a holiday in New Zealand, where she had a good time despite the poor weather.

You can't make this shit up. A HUGELY significant finding that changes treatment from possibly curative to palliative gets a PS, and a vacation in shitty weather gets the headline?


Dear Doctor, please go and look up "priority" in a dictionary before dictating more notes. Your nursing staff will appreciate it.