After reading The New York Times article, Doctors Have Feelings, Too, I began to wonder why so many doctors out of 2000 surveyed withheld information from their patients. The writer of the op-ed piece admitted to withholding the severity of a patient’s prognosis. When the patient asked if the medication prescribed would make her heart better, this doctor did not reveal that not only would the medication not help her heart but that she was not going to get better.
Was this a fatal flaw in this physician’s professionalism or simply an error because the doctor is human?
In my new book, The Take-Charge Patient, I emphasize that physicians are human beings, that just like you and me they can make errors in judgment because of who they are as people. Their personalities or personal experiences can affect how they deal with conflict or upset such as the doctor who wrote about withholding disturbing news from her patient. There’s really no justification for not revealing the truth to patients but I wonder if I were a physician, would I tell a young patient that her prognosis was completely devoid of hope?
How many times have you heard from a physician that the surgery you are about to have will be a breeze with a very short recovery period? As someone who has been through five surgeries, I heard it every single time. When you’re still in pain and unable to go back to work on day three, what are you supposed to think? I’m not recovering as I should? I’m a wimp? I have a low tolerance to pain?
Maybe some doctors put a positive spin on things to give patients hope, to allow for variability without the power of suggestion.
Kind of like not telling a patient about all the potential side effects of a new medication before it is ingested. Doctors have to provide hope that treatment plans will work without loading up the patient with all the things that could possibly go wrong. And what about the patient who was terminal? Should that doctor have told her that the medication she had just prescribed for her heart was doomed because she was terminal?
Trust is a corner stone of a good relationship with your physician and a good relationship leads to better medical care. Trust must be earned on both sides. Patients have to tell the truth to their doctors about their habits, their histories, their compliance with medications and treatment plans. And doctors must also tell the truth to patients about their medical conditions and prognoses. With one possible exception—when full disclosure risks damaging the patient’s sense of hope.
Hope is a funny thing. It gets us through our days, through our marriages, relationships with annoying employers, forges our way with our children’s’ futures. You tamper with hope and something changes in the way both parties foresee the future and how they interact with each other. Perhaps it’s not such a terrible thing to not disclose the whole truth to a terminal patient who has young children. Or maybe it is. Withholding the truth robs the patient of good planning for the future. It can also rob a patient of making the most of what time she has left with her family. It’s not an easy decision and I feel for doctors who have to make those judgment calls.
What I’m suggesting is that sometimes we forget that doctors are human beings. They cry when beloved patients die, get overtired and sick, can get frustrated and self critical when they cannot deliver an accurate diagnosis or treatment plan for a patient. You might not know this because doctors don’t tell us. But with over 375 interviews of physicians and other medical professionals under my belt, I can tell you that on the other side of the door are some very compassionate, conscientious doctors who want to do the right thing. When they fail, many do to themselves what you and I do—we beat ourselves with an emotional stick. When they are treated badly by patients, they react like you and I do—they may just not show it.
Many doctors I interviewed revealed that they are reticent to discuss end-of-life issues with patients. You’d think that this would be an important part of the job, right? End of life issues are difficult for anyone to talk about. Many of us have not created important legal health documents for ourselves if in the event of a tragic illness or injury and we are unable to speak for ourselves. Doctors should be different, we say. Well, they are human and have feelings just like we do. They are professionally trained but real feelings can get in the way of doing the right thing at all times. Should we expect doctors to be perfect? That sounds like a rhetorical question but it isn’t meant to be. When is it fair to have that expectation and when is it not?