title: [Unexpected good news after major surgery: a lesson in communication].
abstract: When dealing with choices concerning life-threatening or major surgery shared decision making, continuous tuning in with colleagues and monitoring direction is a necessity. The gastroenterologist detected a pancreatic tumour in a 53-year-old man. The patient was told that this tumour was almost surely malignant and that he would die within a year. A pylorus-preserving pancreatoduodenectomy was advised and performed. However, the final outcome was an IgG4-mediated autoimmune pancreatitis. The patient felt betrayed by the doctors. Crucial episodes of communication were analysed and we concluded the following. First, in decision-making on life and death, most doctors unconsciously assume a paternalistic attitude, which is not always preferred by the patient. Second, excessive emotional distress of the patient impedes counselling. Third, even in a case of perceived medical urgency, most patients should be allowed some time for reflection. Finally, multidisciplinary consultation may lead to an indistinct ownership of responsibilities by the doctors.
authors.affiliation: Berent Avercamp praktijk, Kampen.
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Zwart
authors.forename: Egbert-Jan
authors.initials: EJ
authors.lastname: van der Wouden
authors.forename: Harry B M
authors.initials: HB
authors.lastname: van de Wiel
authors.forename: Aad J
authors.initials: AJ
authors.lastname: van Leeuwen
mesh_terms: D003142:Communication; D003657:Decision Making; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery; D010195:Pancreatitis / Q000175:diagnosis* / Q000601:surgery; D010348:Patient Care Team; D010358:Patient Participation; D010817:Physician-Patient Relations; D018570:Risk Assessment