A 48-Year-Old Man with an Extensive Smoking History Is Evaluated

A 48-year-old man with an extensive smoking history is evaluated for cough and an episode of mild hemoptysis.  After the patient ignored his symptoms for weeks, his wife finally convinced him to make an appointment.  Chest x-ray reveals a mass lesion in the right upper lobe.  A chest CT scan and bronchoscopy with biopsy are scheduled for that afternoon, and the patient is instructed to schedule a follow-up visit with the physician 3 days later to discuss the results.  The patient agrees to have the tests done but declines the follow-up appointment, saying that he and his wife are leaving for a previously scheduled week-long anniversary celebration and vacation the next day.  Despite education about diagnostic possibilities, he is convinced that his symptoms are stress related and that he will feel better by the time he returns.  The physician is highly concerned that the workup may show lung cancer although the patient clinically appears to be stable.  Which of the following is the most appropriate response by the physician?

A) I am concerned that you may be in denial about the seriousness of your condition.
B) I recommend that you postpone your trip because there is a high probability that this is cancer.
C) I recommend that you postpone your trip so that we can discuss your test results.
D) Please give me permission to speak to your wife.
E) Please leave your information and I will contact you by phone with the results.
F) Please set up an appointment as soon as you return so we can discuss your results.

Correct Answer:

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