Approach to disclosing any diagnosis or providing counselling:
Understanding: get a sense of what the patient/family already knows about the [working] diagnosis and try to elicit their concerns/worries/impression of what this means for them and/or their child.
Permission: ask the patient/family for permission to share some information about the [working] diagnosis, and how much information/detail they’d like you to share at this time
Provide a background of the [working] diagnosis, including a general overview of pathophysiology, reasons why the patient’s presentation is in keeping with this
Give an idea of what prognosis is to be expected for this condition (it is also okay to share uncertainty--if you don’t know what the prognosis is at this point, help the patient/family understand the factors contributing to the prognosis)
Answer any questions the patient/family may have about the condition
Diagnosis: explain the investigations/tests that would be completed to confirm the diagnosis
What they entail (ex/are they painful? Do they require sedation/anesthesia? Are they done at separate appointments or are they done today? How long do the results usually take?)
What you expect to see in the results
What the course of action would be if you find something other than what you expect
Discuss the immediate management options and what the plan will be after today
Discuss possible long-term management options and make a plan or help the patient/family understand how these options will be re-visited and established at a later time
Review possible resources and supports that they can get connected with
Make a follow-up plan including any referrals that need to be made (ex/to supports, specialty or subspecialty physicians, further investigations, etc.)
Ensure that someone can act as a primary contact for the patient/family (ex/the family physician, general pediatrician, etc.)
Review reasons for the patient/family to:
Present to their primary care physician
Present to the emergency department
