Thursday, May 21, 2009

Hiding Diagnosis from Patient

Rosemary Flanigan
May 21, 2009

I am musing over family's instructions to caregivers, "Don't tell. . . ." and I thought back to the 50's when my dad and I took my grandmother to a physician to check a canker sore (?) that wouldn't quit.

The physician examined her, closed the door between the examining room and the waiting area where we were sitting and told us it was cancer. To the best of my knowledge, for the following six months neither of us spoke the "cancer" word to her.

I shall spend the first few eons in heaven apologizing to her for that!!!

I wondered how professional providers could hide a diagnosis from their patients. Do they justify it by compassion or sensitivity? How can the patient consent to treatment if he/she doesn't know what the treatment is for?

HELP! I know the practice is still going on. How is it justified??



Blogger Practical Bioethics said...

I would echo comments regarding the role of the physician in choosing not to reveal the truth.

I may not have the dates correct, but the AMA Ethical Standards included not revealing truths to patients, when in the judgment of the physician, it was not in the best interest of the patient.

I think that was in place into the mid-1970's, when it was removed.

Today, the myriad of options of therapy may make truth-telling nearly always in the best interest of the patient, so they can choose a path that may offer cure, or prolonged survival, or preparation for a limited prognosis. But I can understand why physicians historically treated with little more than compassion and personal attention....

John D. Yeast, M.D., M.S.P.H.
Vice President of Medical Affairs
Saint Luke's Hospital of Kansas City

Thursday, May 21, 2009  
Blogger Practical Bioethics said...

I think of the changes in healthcare delivery since the 50’s, and I can see where many of you interpret my guilt over withholding information from my grandmother as an “autonomy” issue.

But what if my reasoning now is NOT “In order for the patient to give informed consent, he/she must be told. . .” but rather the integrity of medicine. How does the physician decide whether to heed the “Don’t tell. . .” or not?

Are we perpetuating that paternal “benevolence” that so characterized doctoring in the past?

The wife of a recovering patient said to me just this morning, “All we wanted when he was in the hospital was the truth as the doctors saw it.”

It just so happens that I have Ed Pellegrino’s 2002 journal article on professionalism at my left hand, and I read, “Truthfulness—because the patient is owed the knowledge necessary for making informed choices, so he can make plans for his own life when disease disrupts those plans, and so he can assess his doctor’s competence to undertake what he proposes.” (The same is true for FEMALE patients, too.) “. . .to assess the doctor’s competence. . . .”

So truthtelling is for the physician’s own good—yes!

Rosemary Flanigan

Thursday, May 21, 2009  
Blogger Jay said...

I ask the patient, when I can. I start by asking what she already knows, and what she suspects, and then I ask how she wants me to proceed after I have the results of the tests. If the patient tells me, directly, that she wants her family to decide how much she knows, then I will do that. I probe to find out the underlying concerns and values, but some of my patients really don't want to know. If I don't hear that from the patient, then I work with the family to get to a point where they will tolerate - not allow - the conversation with the patient.

Truthtelling is one imperative, but if the patient doesn't want to know then truthtelling can actually violate autonomy. It's a complex balance. My integrity demands that I attend to the patient's and family's underlying values as well as the rules of American medical ethics, as I understand them.

Saturday, May 23, 2009  
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Wednesday, March 30, 2011  

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