TELLING THE TRUTH

«  “How much to tell lies somewhere between too little and too much.” (Tom West)

In the past many doctors held the view that patients with serious diseases should not be told. Apparently doctors felt that knowledge of the true diagnosis would cause demoralization and despair. However, the idea that avoidance is somehow protective is a false assumption. Avoidance does not help patients adjust to their situation.

The principle of “primum non nocere” (first do no harm) is sometimes used to defend the stance of deception. The patient will of course be distressed by the doctor’s words when bad news is broken, but to argue that a discussion (skillfully conducted) should therefore be avoided is analogous to saying that a surgeon should not cut his patient as it would cause avoidable suffering.

Against the anguish of finding out must be set the benefits of knowing. Several studies have shown that the great majority of cancer patients want to be told the truth.

Patients tend not to press for information and yet they need information for many different reasons:

• Relief of uncertainty

• Discussion of future needs

• Planning for the future (legal, financial)

• Attending to unfinished emotional business

• Avoiding deceit

• Maintaining open communications

• Preparation for death

Giving a patient the opportunity to ask in detail about the diagnosis also avoids the all-too-common devastating situation when a patient discovers the true diagnosis by accident, perhaps by overhearing a conversation.

A better question than “Can the patient stand being told?” is “Can the patient stand not being told?” However, the decision to be honest brings with it a duty to explain and support.

It is tempting to tell too little, perhaps to avoid upsetting and disappointing the patient, but it can destroy trust, and can cause anger and resentment later on. Telling too much can cause anxiety and fear. (see Breaking Bad News)

«  “Truth, like medicine, can be intelligently used, respecting its potential to help and to hurt.” (Avery Weisman)

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.