Friday, October 24, 2008

Breaking bad news - how much to tell ?

Breaking bad news is one of the most difficult tasks a doctor has to perform. It's also one of the most difficult ones to do well - and many doctors never manage to do a good job with this. There are many reasons for this and the most important is that every patient is different - and every patient's needs as regards being told unpalatable news are different . Some would rather hear all the gory details, so they can arm themselves with the information they need, and then find the right solution. Others would rather shield themselves from hard reality - and let the doctor make all the decisions. For most of us, we'd prefer a balanced mix between these two extremes - Gautam Buddha's middle path !

The trouble is that the doctor has no way of divining which our preferred coping style is. This is why most develop their own preferred style, depending upon their own personality. Many take a paternalistic approach, where "the doctor knows best" and routinely censor all information, because they do not want the "shock" of the "bad news" to unduly distress the patient. Others, who believe that "honesty is the best policy", spill all the beans dispassionately and heartlessly, which is why many patients now believe that doctors are uncaring and unfeeling.

Many doctors tell the unvarnished truth to a relative of the patient, who acts as the patient's advocate. This person can then present the truth to the patient in a style which the patient is comfortable with. While this is a great model in theory, in real life it often fails miserably, especially in Indian society, where we take great pains to not use words like cancer in the deluded belief that hearing the truth will cause the patient to hasten her way to an early death.

Sometimes , hiding the truth from the patient is the unkindest cut of all - even though it is done with the kindest of intentions !

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