You are asked to tell a patient that his investigations are consistent with motor neurone disease. How would you approach this consultation?

Question

A 61-year-old man has had eight months of progressive limb weakness and dysarthria. Neurophysiology and imaging are consistent with amyotrophic lateral sclerosis. He has attended alone and has asked at every visit whether it could be 'something serious'.

Accepted Answer

I would prepare first: confirm the neurophysiology and imaging myself, book real time rather than a routine slot, find a private room, hand over my bleep, and have the MND specialist nurse available. He has come alone, so before anything else I would acknowledge that and ask whether there is someone he would like to be here, either in person or on the phone. I would open by asking what he understands so far and what he has been most worried about. A man who has asked at every visit whether it could be something serious usually has a shape of the answer already, and what he tells me will change how I say it. I would then fire a warning shot — that the tests have shown something serious — pause, and give the diagnosis in plain words: that the findings are consistent with motor neurone disease, a condition affecting the nerves that control muscle. I would use the name rather than a euphemism, then stop talking. Silence here is the intervention, and I would resist filling it. I would respond to whatever comes back — shock, anger, questions — before adding information, and I would not volunteer prognosis unless he asks. If he does, I would be honest about uncertainty rather than give a figure, and promise to be honest at every stage. Then I would give him something concrete: referral to the specialist MND nurse and the multidisciplinary clinic, the surveillance of respiratory function and nutrition that will happen, a discussion about riluzole, and written information from the MND Association. I would arrange to see him again within a fortnight with someone present, because he will retain almost none of this, write to the GP the same day, and debrief afterwards with the nurse who was in the room.

Communicating a New Diagnosis of Motor Neurone Disease

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