Section: USMLE

46) An oncologist tells his patient that her laboratory results support a diagnosis of advanced malignant melanoma with multiple metastases to the liver and brain. He also advises her that the prognosis is poor. Which of the following is most likely to be the first statement that the patient will make?

1. "Can you keep me alive until my daughter graduates from medical school?"
2. "Damn you doctor, you should have caught this earlier!"
3. "Doctor, you must be wrong."
4. "I think it is time that I make a will and say good-bye to everyone."
5. "It's no use, I always lose and get the short end of the stick."

Kubler-Ross’s Death and Dying sequence is a stepwise process with five identified stages, which occur in the following order: 1) Denial, 2) Anger, 3) Bargaining, 4) Sadness, and 5) Acceptance. "Doctor you must be wrong" is the correct answer since it reflects the patient's inability to accept the information and indicates the denial of the first stage.

"Can you keep me alive until my daughter graduates from medical school", is a statement from the third, or bargaining, stage.

"Damn you doctor, you should have caught this earlier" is a statement from the second, or anger, phase.

"I think it is time that I make a will and say good-bye to everyone" reflects the patient's acceptance of the reality and is a statement from the fifth phase (acceptance).

"It's no use, I always lose and get the short end of the stick" is a statement from the fourth phase (sadness).