# Should doctors tell their patients the truth about the state of their health?



## Etcetera

That is the question. Should the doctors tell their patients about the *true *state of their health?
On the one hand, we usually expect the doctors to be honest and sincere with us if we happen to be in their charge. 
On the other hand, I have to admit that I'm not sure if *I *would like to hear all that the doctor have to say about the state of my health. When I was a child, I used to spend whole days in hospitals, and most of all I hated the doctors when they were telling my Mum the results of their "efforts". They were making her cry, that's what they did. Although the situation wasn't as "awful" as they used to think. 
So, what do you think? Should doctors always be sincere with their patients, or there are some details which are better kept secret? 
I know there can be no definite answer to that, but I want to know your opinions on the subject.


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## maxiogee

Unless informing the patient of their true condition would greatly worsen the patient's situation, then I think a doctor *must* inform their patient. They are the patient's "employee" in the relationship.
I cannot understand what allows a doctor to presume to withhold information.
I know I'm going to die sometime.
I know it might not be a comfortable experience - I watched both my parents die most un-comfortable deaths.
I might not be ready for it to happen too soon.
But… I cannot see what a doctor might decline to tell me which would improve my situation where I to be suddenly afflicted by some dire illness/disease.


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## cyanista

You might want to read this thread, Etcetera.
http://forum.wordreference.com/showthread.php?t=143653&


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## Etcetera

cyanista said:


> You might want to read this thread, Etcetera.
> http://forum.wordreference.com/showthread.php?t=143653&


Thank you for the link. 
Since my question is more general, I hope the Mods wouldn't decide that this thread just repeats the previous one...


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## cuchuflete

Greetings Etcetera,
I find that most people I know, and I for that matter, have quite a lot of resiliancy.  We can accept sad and even tragic news, eventually come to an accommodation with reality, and move on to either address the problem, or simply accept it and turn our attentions elsewhere.  

What is most debilitating is uncertainty.  If we have reason to suspect a serious medical problem, and get vague and uncertain words from a doctor, this may well drain more energy than confronting bad news.  I agree with Maxi that doctors have an obligation to be truthful, unless to do so would have a bad medical effect.


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## pedro0001

I can't find any reason why a doctor should lie about what he/she has found (any at all). Or I don't really understand your question etcetera.


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## Elibennet

Doctors dont lie. The ones who may choose to lie are the relatives of the patients.


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## .   1

The doctor can not know everything about the rest of the life of the patient and so must inform the patient or the parents of the patient so that whatever personal steps that are necessary are able to taken.
If doctors routinely withhold such information there will be too much uncertainty in the minds of all patients.

.,,


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## french4beth

Doctors need to tell the truth - they just have to be careful how they tell it; for example, they need to be sensitive to the situation (in my opinion, most doctors do a good job of this). As with any other profession, there are some doctors who may be excellent technically, but don't express themselves well - either they give too much technical information & talk over the patient's head, or they are too unemotional & come across as unfeeling.

In the past, I think it was more common for doctors to withhold information, but I don't that think that this is true today.  I can't say for sure, as fortunately, I am in excellent health, as are all family members.


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## maxiogee

Elibennet said:


> Doctors dont lie.



That's a *sweepingly* broad generalisation - and there are more ways of not telling the truth than just telling a lie. There is not answering the question asked, there is withholding information, there is clouding the issue with the use of technical terminology, and there is improper presentation of a set of alternatives.


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## jinti

Some years ago, my father suffered sudden cardiac death, which means that his heart stopped -- for about 13 or 14 minutes. He survived, but what I saw when I got to the hospital was pretty bad. I asked numerous doctors and nurses what his chances were. All they would say was that there's always hope.

Well, he did recover. He is brain damaged, but still quite functional and his personality is there. He cooks meals, gets around on his own, participates in a football pool, is experimenting with blogging.... 

I think that some of the reason for his miraculous recovery was that medical intervention was done quickly and correctly all the way through. Some of the reason was that he has always had a wonderful ability to heal quickly. But I also think a lot is due to the fact that my family stayed with him around the clock for days, talking to him and touching him, encouraging him to come back to us and providing stimulation as his brain worked to heal itself. 

Would we have done all that to the degree that we did, if the doctors had told us the truth at that time? -- that they had never seen a case of oxygen deprivation that bad, that 8 minutes was considered the outer limit of reversible brain damage and my father had been gone nearly twice that time, that even if he managed to survive, there was no expectation he would ever even recognize his family again, much less speak or walk... I don't know. Maybe we would have still done all that. But it would have been harder. When the doctors said there was always hope, it was meant as a kindness to us although I'm sure not all of them believed it even as they said it.


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## french4beth

Jinti, I'm so happy to hear of your father's miraculous recovery!

Your story made me think of an interesting point - doctors & other health professionals need to be _really_ careful about what they say when a patient is supposedly unconscious (whether under anesthesia, in a coma, etc.). Patients have reported that they heard & understood what was said, even though they were in an altered state; if a doctor says flippantly, "This one's a goner!", who knows if this will affect the patient's recovery?


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## Etcetera

Jinti, I'm much impressed by your father's story. 
I agree with French4beth - the doctors should be very careful about theiir words, and of course they shouldn't say that their patient is going to die. There's always miracles... 
A tiny hope is always better than despair!


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## duckie

Jinti's story is remarkable, that's an extreme recovery.

Sometimes there are stories of doctors who say that a patient has x amount of time left to live. I know several doctors, but none of them would say that and in fact it's a very problematic thing to say. Such statements are based on statistics for patients in similar situations, but precisely for that reason they can only be considered guidelines and by no means be applied to a person with certainty. The result when a doctor makes such a claim is likely to depress the patient instead of having him or her mobilize inner strength and fight back.

Quite simply, a doctor should not lie - and not knowing something means not knowing it. In Jinti's case they couldn't know for sure, so they could say that there's 'hope' (i.e. a possibility, even if very remote) simply be default. In my view this is the correct procedure, just as it would be for any other situation where there's an uncertainty.


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## Etcetera

duckie said:


> Sometimes there are stories of doctors who say that a patient has x amount of time left to live. I know several doctors, but none of them would say that and in fact it's a very problematic thing to say. Such statements are based on statistics for patients in similar situations, but precisely for that reason they can only be considered guidelines and by no means be applied to a person with certainty. The result when a doctor makes such a claim is likely to depress the patient instead of having him or her mobilize inner strength and fight back.


That's it. I would hate a doctor telling me I have some 3 months left. It would certainly upset me - not the very statement, perhaps, but the fact than the doctor is so sure about it. Maybe I would decide to live more just to confuse the doctor.  But a lot of people would get upset and think that's no hope for them. 
I myself take each word of any doctor with a grain of salt. But there are many people who blindly believe them.


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## duckie

That's the problem with all people - not just doctors - who ignore their doubts (in this case statistical uncertainty or just plain mistakes) and present their personal judgement as the definitive answer.

Unfortunately when a doctor is arrogant like that the result tends to be very serious.


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## maxiogee

Etcetera said:


> That's it. I would hate a doctor telling me I have some 3 months left. It would certainly upset me - not the very statement, perhaps, but the fact than the doctor is so sure about it. Maybe I would decide to live more just to confuse the doctor.  But a lot of people would get upset and think that's no hope for them.
> I myself take each word of any doctor with a grain of salt. But there are many people who blindly believe them.



My mother was diagnosed with lung cancer. 
Some time after she had had part of her lung removed she was 'given' six months to live. She died almost thirty-years of related illnesses, but not of cancer.
The awareness of her potential 'shortevity' changed certain opinions - her's and others' —> bringing a re-evaluation of certain importances.


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## Seana

Hallo,
I know it from my personal observation. 5 years ago my husband underwent treatment at our best Polish clinic. He had very rare kind of the bone cancer. The diagnosis came suddenly. We faced with this terrible misfortune as everyone - completely unprepared. The doctor didn't hesitate in any moment with discussing with us even every smallest detail of curing.
It was almost inhuman for us but after first shock I was regarding it as very normal and justified situation because nowadays it happens the cancers are curable in many cases but new generation therapies are murderous. They need to have so much perseverance.  The patients  must cooperate and find a huge motivation to win. But when I asked my husband whether he would like to know about his hopeless situation after using all possibilities of curing... he has answered -* NO*.


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## Cracker Jack

The patient has every right to know the diagnosis no matter how dismal it is.  It is an inherent right of every patient to know what is going-on with his body.  This knowledge enables him to make decisions about what next step is to be taken.

However, there is a ethical-related question based on the opinion of he next-of-kin.  The manner of informing the patient is an art that a physician has to muster.  The best way is to tell the patient in a way that doesn't give him false hopes, of course in a diplomatic way.  This applies in cases wherein the a prognosis of terminal illness is expected.  

The patient of course has the option of deciding what to do if he is fully conscious and aware at the time the diagnosis is made.


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## geve

maxiogee said:


> That's a *sweepingly* broad generalisation - and there are more ways of not telling the truth than just telling a lie. There is not answering the question asked, there is withholding information, there is clouding the issue with the use of technical terminology, and there is improper presentation of a set of alternatives.


And sometimes there is not "one truth" - sometimes doctors have no certitudes... should they share their doubts with the patients?

I would logically answer "yes". But then I remember when we didn't know what was happening to my father, why his recovering from surgery consecutive to a car accident suddenly stopped and reversed. Doctors didn't know yet what he had (he is now fully healed). At that time my uncle was with us - he's a doctor - and he told me that he could think of several hypotheses. I didn't ask him what these hypotheses were; seeing his worried face was enough to scare me.


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## Cracker Jack

geve said:


> And sometimes there is not "one truth" - sometimes doctors have no certitudes... should they share their doubts with the patients?
> 
> I would logically answer "yes". But then I remember when we didn't know what was happening to my father, why his recovering from surgery consecutive to a car accident suddenly stopped and reversed. Doctors didn't know yet what he had (he is now fully healed). At that time my uncle was with us - he's a doctor - and he told me that he could think of several hypotheses. I didn't ask him what these hypotheses were; seeing his worried face was enough to scare me.


 
It does occur that misdiagnoses are made.  In this case, sometimes it takes time before a doctor can inform the patient about the diagnosis. Some doctors order thorough and exhaustive diagnostic procedures to cme up with a definitive and seemingly peremptory diagnosis. Of late, defensive medicine has been practiced in the light of malpractice suits that patients have filed against doctors.  The courts on the other hand, have awarded millions to patient-plaintiffs.

However, if everything comes to a naught, and patients may not be convinced, there is always an option of seeking second opinion, that may either concur or deviate form the initial diagnosis.  All these are employed in the interest of the patient who is in a terminal stage.


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## micro

Hello,

from a Catholic point of view (maybe also for other Christians) there is a prayer that says something like "Lord, free us from sudden death", because you need to prepare yourself, and you don't think life will finish with death.
So I think the patient should know what will be (or what the doctors suppose...).
Anyway, maybe your question was more general (not limited to deadly illness), and also I do not have a direct life experience on these matters (for me or close relatives), so I don't know what I would do actually.


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## maxiogee

micro said:


> from a Catholic point of view (maybe also for other Christians) there is a prayer that says something like "Lord, free us from sudden death", because you need to prepare yourself,



Should not a 'good' Catholic live such a life that they can rest assured that they will be among the righteous when they die?

One wouldn't want to be a foolish virgin, would one?


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## Bonjules

Hello all, 
it is notoriously difficult to make generalizations about this ethical dilemma.
All cases are different, even within the same disease. Let's take cancer.
True, there are many more therapies avaiible now, some w. terrible
side effects. In reality, even with aggressive cancers which are almost always fatal w/i a few months once the have gone beyond the initial spot (most have @ the time of diagnosis, pancreas is a good example) patients will seek treatment, chemo, whatever, even surgery. The truth is that it will do little in these cases to prolong
life, esp. good quality life. What should the Oncologist do? He/she needs to say just that. More often than not in these sit.'s the focussing on 'fighting the disease'
prevents the person from enjoying the time they have and prepare well for
their passing. But then, there are those who enjoy 'the fight' and would never think of just
accepting their fate. Either way, here the patient must know every detail if he wants, esp. the outcome statistics of treatments attempted.


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## duckie

But what I see you say is that doctors should indeed tell the truth, so where's the dilemma? As far as I'm concerned the dilemma is not about telling the truth, but to figure out how much information people want.


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## Bonjules

Well, yes, it is a dilemma, all the way.
Often the patient does not want to hear the (whole)truth if painful.
Do you cram it down their throat, take away their hope, but
give them a chance to go through 'the stages'? Or, by 'respecting
their wishes' (not to know all) do you become part of a dirty little secret?
Actually few get really a chance to come to terms with their passing
and have their family share in that process because of exactly that.
Many docs take the 'escape route' by telling the family, not the patient,
therby 'unloading' it onto their shoulders. Considering that they are in exactly
the same dilemma and your primary responsibility is to the patient, this is not very satisfactory either.


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## duckie

I don't think there's any dirty secret about respecting people's implicit request not to be told everything. A person has the right to know, and a person has the right to decide how much she wants to investigate her own life. I would say the difficulty lies in figuring out what exactly people want to know, but I would strongly suggest erring on the side of telling them more rather than less.

I don't think we're really disagreeing though..


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## Victoria32

Etcetera said:


> That is the question. Should the doctors tell their patients about the *true *state of their health?
> On the one hand, we usually expect the doctors to be honest and sincere with us if we happen to be in their charge.
> On the other hand, I have to admit that I'm not sure if *I *would like to hear all that the doctor have to say about the state of my health. When I was a child, I used to spend whole days in hospitals, and most of all I hated the doctors when they were telling my Mum the results of their "efforts". They were making her cry, that's what they did. Although the situation wasn't as "awful" as they used to think.
> So, what do you think? Should doctors always be sincere with their patients, or there are some details which are better kept secret?
> I know there can be no definite answer to that, but I want to know your opinions on the subject.


Definitely, in my view doctors should tell the patient as much (or as little) as they want to know, or are capable of understanding.
When I was a child, I was similar to you, Etcetera. spent a lot of time in hospitals, and the doctors may have told my parents what was going on (I don't know and can't ask now, as they're long dead) but no one told me anything, even when I was old enough to understand.
My son is a nursing student and he tells me the policy now, is to tell _*whatever the patient wants to know*_.
They are very big now on 'patient autonomy' and the patient can't be autonomous if she is kept ignorant!


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## Daddyo

A friend of mine was actually beating the breast cancer until, for no reason at all, it metastasized. On a regular follow-up visit to the doctor he informed her that she was already a stage four and would die in a few months. She died a few weeks later from complications. I wonder if the shock of finding out she was so ill when she believed she was actually going to beat the cancer contributed to her accelerated demise.
It is difficult to say if many cases are similar, and if they are, even more difficult to figure out if doctors should tell patients the whole truth and nothing but the truth.


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## duckie

The problem, once again, is that in that case the doctor said 'you have x amount of time left to live'. That is based on statistics and is not very useful. Explaining the stages of cancer and what has been observed would be a lot more accurate, and should be completely standard.


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## Daddyo

I suppose the doctor had already done all the explaining _the first time around_ when my friend was diagnosed with breast cancer. When he announced to her that she went from remission to a _terminal_ status, he was more than probably giving her the worst case scenario, because it seems it was all that could be done in this particular case.


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## Etcetera

Victoria32 said:


> My son is a nursing student and he tells me the policy now, is to tell _*whatever the patient wants to know*_.


So, if the patient wants to know everything, the doctor should tell them everything, but if the patient doesn't ask questions, it's up to the doctor to decide how much to tell them?


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## Bonjules

yes, Anna,
since, at the end of the day, all of this is about decision making
which requires 'informed consent', the doc has the basic duty to
lay out all the facts.
This, as has been pointed out can be very tricky, if the patient
'resists'. Furthermore, if you are in the docs position it is almost impossible
not to let your own attitudes re matters of Death and Life (and
the 'quality' of the latter) shine through.
Even worse is the situation if you can't communicate with the patient
(e.G. he/she is in a coma) and quick decisions have to be made. Then
one routinely refers to family, husbands/wives etc. for 'guidance'. What
if you think they aren't 'reasoanble' or have their own agenda (fear 
of loss, guilt)? Also, aside from religious considerations, our capacity(as humans)
for 'denial of reality' is almost limitless (see my Sig). A huge problem.
There is often no time to consult with an 'Ethics Committee' which most
bigger Hospitals now have.


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## Victoria32

Etcetera said:


> So, if the patient wants to know everything, the doctor should tell them everything, but if the patient doesn't ask questions, it's up to the doctor to decide how much to tell them?


I believe it is a matter too, of how much the patient is capable of understanding... but the main thing is informed consent, _which the patient can't give if she is not informed!_
Sometimes, the patient doesn't want to know. I would, as would my son if he were the patient and not the nurse. 
My daughter-in-law is ill and in hospital; (the wife of my other son.) She wants to know what's going on, but I think (they might not agree) that her husband is such a worry-wart he's better off not knowing unless he has to. She's a nurse herself (or she was - she had to give up because of health problems) 
The doctor should tell all s/he has to, and never withhold information from the patient - and it is up to her if the family is told anything.


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