Below is an illustration of medical decision-making and informed consent on a breast medical condition.
A 45-year-old female who had a history of macrocysts of the breast and which had been aspirated twice came for a check-up.
On examination, there was a questionable dominant mass on the left breast, about one-centimeter prominence.
A differential diagnosis of fibrocystic change (primary diagnosis) and macrocyst (secondary diagnosis) was given and explained to the patient.
Options given to the patient and advantages and disadvantages explained:
- Watch and wait – long wait of one month (for re-examination) – advantage: prominence may disappear.
- Ultrasound of the breast – early information can be gotten, whether fibrocystic change or macrocyst – if macrocyst, treatment options could be needle aspiration or just watch and wait (observe) – if fibrocystic change, just monitor (no procedure needed).
Patient decided to have an ultrasound done. Note her signature below the ultrasound option signifying her decision. This is an illustration of an informed consent.
Other patient may choose the watch and wait option, in which case, she will sign on the watch and wait option.
Follow-up – 17may18
Ultrasound of the breast was done which showed multiple cysts. The prominence that was noted at about 1 o’clock position on the left breast showed a 2.1 cm cyst on ultrasound. Since the cyst was not discrete on palpation and since it is just a macrocyst, shared decision was just to observe, watch and wait, and follow-up in 3 months.