The Difficult Clinical Conversation

Dr. Smith’s first patient of the day is a 63-year-old woman, Mrs. Meyer, who has persistent diarrhea and a weight loss of 10 pounds (from 92 pounds to 82 pounds) over 2 months. She is widowed and has three daughters who live in town. When Dr. Smith asked about her past medical history, she indicated that she smokes about two packs per day, consumes about two drinks per day, and has been hospitalized once for an appendectomy and for the births of her three children.