Tuesday, January 25, 2005

The Don't Tell Scenario: Part 2

Thank you to all of you who commented on my last post. You all clearly put a lot of thought into your responses and shared so much of your personal lives. I learn so much from you as well as from my patients!

I don't really know the answer to this scenario. I don't think there is one definitive answer. Just as the diversity of your responses shows - I think each patient needs to be approached individually.

Interestingly enough, just today, I came across an intake form for a palliative care program at another hospital. On the form, they asked:

"The news of my updated health status may result in the need for additional information and decision-making about my care (please check all that apply):

"I want to understand the meaning of my health status and what my future holds.
"I want the doctor to answer only the questions that I ask.
"I want the doctor to talk to my (partner, spouse, son, daughter, father, mother, or ________) instead of me about my health status.
"I only want the doctor to talk to my loved ones with me present."

Although I think forms are helpful, as RisibleGirl illustrated in her comment, they come with certain risks. But why not ask each patient this question in person?

Let the patient decide for him/herself what they feel they are ready to hear. And if they say, "I want you to only talk to my family," then fine. The patient concurs with his/her family's wishes. If they say, "I want the doctor to answer only the questions I ask, then tell the family what the patient said and answer her/him honestly.

Secondly, I would also suggest following any question of "Why am I here?" with "Why do you think you're here?" which is actually what I did in one of these types of situations. Often, even if the patients have never been told outright, they suspect that they may be terminally ill. If you open that conversation, they may tell you for themselves.

This was not an easy question or dilemma. I have been in a similar situation a couple of times and spent long hours grappling with what to do. Thank you - each of you - for sharing your input. I hope you read each others' comments, too. Again, I learned tons from each of you. And I hope you found the scenario thought-provoking. Thanks again.

What do you think? Shall I come up with another scenario?

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