It gives me no pleasure whatsoever to be the bearer of bad news in any situation, but in the clinical context, it is even worse. When I have to tell people that there is nothing I can do to help them, it feels dreadful.
The ‘I can’t help’ conundrum
I had a gentleman present in my clinic last week, on crutches, unable to stand straight or sit up. His only comfortable position was lying on his side because of the great pain he was experiencing in his back and leg. In these situations, often, even before exploring the case history or performing an examination, gut feeling kicks in and says “don’t touch”.
Naturally, I took all the relevant details, thoroughly questioned the gentleman about his problem and then performed as much of an examination as was possible in the circumstances.
It was one of those unfortunate ‘I can’t help’ situations, there was almost definitely a significant injury to one or more of his discs and perhaps even more unfortunately, he had been referred by someone who had made all sorts of outrageous claims about my abilities!
What can be done in an ‘I can’t help’ scenario?
I really don’t like letting people down and It would be a complete tragedy if there was absolutely nothing I could do.
Yes, there was nothing physically that I could do to help, I considered that any intervention from me had as much chance of making it worse as better and nobody wants that.
Fortunately for the gentleman who came in, here is where his luck changed a bit, I had, 30 minutes earlier, taken a cancellation for the session directly after his and so I did what I always do in these kind of situations. I wrote a letter.
That may not sound like much, but it was a summary of the condition, my findings, my opinion and recommendations for further action (MRI scan). Addressed to whom it may concern so that it could equally be taken to Accident & Emergency or the GP.
‘Can’t help’ can still help!
It still feels pretty bad having to tell someone about serious spinal damage. But even if all I can do is to provide a patient with a written summary of the session and my professional advice, then I have done something and hopefully they will get some benefit by being seen sooner or taken more seriously.
Despite the title, there is always some way we can help people, no matter what the problem or how big it might be.
