Monday, June 29, 2009

Should doctors be frank and forthright ?

Everyone agrees doctors need to be honest with their patients, but this is fine only in abstraction. The real question is - how brutally honest do you want your doctor to be when it's you are ill ? This can be a difficult question to answer, not only for patients, but for doctors as well ! Thoughtful doctors do their best to judge how much truth a patient can accept at a given time - and then provide the truth, in a form they feel will be palatable for the patient, in titrated doses.

Let's take a patient who is terminally ill.
When should the doctor tell him ? Tell his relatives ? How should he tell them ?

Good doctors learn how to tell bad news with grace - while others mess this up or delegate this job to their juniors, doing both their patients and themselves a major disservice.

Good doctors tell patients the truth because they respect them and they feel it's in the patient's best interests that he knows the truth. Others will simply follow a "tell the unvarnished truth policy" to protect themselves, because they need to protect themselves from a possible malpractice suit.

And it's not just when patients are terminally ill that doctors face these dilemmas. It can be a problem in all specialties, including IVF. For example, I saw a patient today who has testicular failure and who cannot have a baby with his own sperm. How do I break the news gently to him, without causing him harm or hurt ?
How much truth can he accept ? How do I judge this for each individual patient ?

I don't want to be cruel and take away his hope ? But don't I have a responsibility as a professional to tell him the unvarnished truth ? If I don't he may end up wasting time and money pursuing ineffective treatment from quacks. I agree having to deal with a hopeless situation can be cruel - but false hope can be even crueller. Often it's better to know the truth no matter how bitter it is, so patients can deal with it and move on with their lives. Many of them are much stronger than they realise - and a crisis can be a challenge and an opportunity as well !

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