What if she really doesn’t want to handle the truth? Nuanced discussion of how to inform patients of a terminal diagnosis
This article in the Guardian, Should a doctor always disclose a terminal illness?, had me hopping at the title.
Should a doctor always disclose a terminal illness? Absolutely yes. Every time.
Then I read the article. It gave me pause.
Doctors and other health care providers must be truthful and forthcoming. But, it gave me pause because that conversation when sharing the worst news of someone’s health status is nuanced, individualized and contextual.
I teach health care providers about consent and informed consent. There is a legal test. It is clear and I can repeat it for you any time anywhere and I do.
What I liked about this article was the backstory of one of these conversations. In the context of family milling around and language barriers and interpreters and culture clashes.
Not going to lie – it made me uncomfortable. Part way through I was thinking: “oh, let’s not go there that people who don’t speak the primary language don’t get the same information as those who do.” and I was also thinking “I get it that some families don’t want their frail elderly fully informed about their situations – but those frail elderly get to know!”
But the story is so much more. Sensitivity. To have these conversations there must be space for listening to what the patient wants. How the patient wants to hear the information. How the patient’s family needs to be involved and considered.
The author writes: Finally, we will never know what patients want if we fail to ask. We should assume nothing but respect an individual’s decision to know only so much. Navigating this fine line comprises the art of medicine.
This article is a must read for all of us in health care who are committed to being patient-centred. This is a story of living in the simplicity and complexity of those day to day to day to day conversations and striving to do the right thing. The answers are asking and listening.