Does not read

When I first saw this patient, there was a note in the chart from the front desk saying "patient does not read". I asked if this was a deliberate decision from the patient, or whether they had meant to say that the patient was illiterate and could not read.

Unfortunately, the latter is true. The patient is a retired janitor who is somewhat "developmentally delayed" (I think that's the current correct term), and has never been able to learn to read. He has no family and is functional enough that he does not have a guardian or someone with power of attorney.

This poses a difficult situation because I diagnosed him with prostate cancer after doing a biopsy, and tried to explain to him all the options available for treatment. Prostate cancer is a disease where there are several treatments choices available (surgery - open or laparoscopic-, external beam radiation, brachytherapy, cryotherapy, observation etc...), and the urologist and the patient arrive to a decision together after much discussion.

Well, there wasn't much of a discussion with this patient because he did not truly understand all risks and benefits involved with each option. I did send him to see the radiation oncologist who agreed with me that the patient has limited comprehension about the options.

The patient is quite pleasant. He will follow all the instructions we give him, and our staff has been working extra hard to call and remind him of all his medical appointments (X-ray, labs, office visits etc...). But this is a tricky situation. The patient obviously needs treatment, and I am in the awkward position of deciding for him what the next step should be.