Was this doctor in the wrong?

Hissy_Fitz
Hissy_Fitz Member Posts: 1,834
On another board, a member posted that she had posed a question to her oncologist's wife (an internist, I think), a doctor she had consulted professionally for other issues. She asked (and I'm paraphrasing here) a question about the future "for someone like me." The doctor responded that the cancer "will kill you." "Right now," she said, "We are protecting you from the rain, but eventually a tsunami will come along and sweep you away."

The poster has been bothered by this for the last two weeks and wanted to know if she should confront the doctor next Wednesday, for being so "insensitive."

Everyone (except me) was outraged at the doctor. They all felt she should have said something more "encouraging."

I, on the other hand, think that if you ask a direct question, especially from a doctor, you should be prepared for an honest answer. In fact, I think doctors are pretty much prohibited from lying to their patients.

Maybe I am just an odd duck. I mean, it's fine to be eternally hopeful, or even in denial, if that makes you feel better, but are other people obligated to speak what they essentially believe are lies? Is it right or fair to put anyone in that position?

Don't ask, don't tell is one thing, but would you be angry at your doctor for something like this?


Carlene
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Comments

  • Mwee
    Mwee Member Posts: 1,338
    If you're an odd duck, I'm quacking with ya
    It's so very hard to hear the real truth from your doctor, but would we want them to candy coat our illness? My doctor loves my positive attitude and encourages it, but when I ask a question, I get the truth. It's not pretty, but I wouldn't call it insensitive.
    Quack, Quack Maria
  • Tethys41
    Tethys41 Member Posts: 1,376 Member
    Be prepared
    I admit, I tend to be a realist, and somewhat lacking in compassion when it appears that someone has made their own bed. My feeling is this, if you don't want to hear what someone may say to you, then don't ask. I didn't and have not asked any of my oncologists what my chances are, for just that reason. I prefer to believe that I am cured and my conflict with this disease is over.

    On the other hand, whenever anyone approaches me about a topic such as this, I don't want to be the negative input that pushes her over the edge. One thing I know is that I don't know. No one knows what will happen to any one of us. The statistics, I feel, are just data, and do not determine the outcome of any one person's situation. That is why I don't like seeing the percentages posted on this board. Yet whenever anyone asks about cures and outcomes, these numbers always pop up here. I guess one could ask the same question about whether it is appropriate for members of this board to respond with the statistics when not asked specifically for this information.

    That being said, however, I think this person's doctor's response was unduly dramatic. And I would support her if she told this doctor that her bedside manner needs some help. If I were in her shoes, I would consider discontinuing my relationship with this doctor.

    The two oncologists I worked with originally held their cards close to their chests, which was probably a good thing when I was really sick, because I'm sure that any information about survival back then would not have served me well. Recently I started working with another gyn/onc who is very positive about survivability. I truly appreciate his positive energy.
  • srwruns
    srwruns Member Posts: 343
    If you ask a question be
    If you ask a question be prepared for the answer. As for sensitivity...that's in the eye of the beholder. It sounded like a pretty good analogy to me. I've heard some folks complain that their doctor was never really upfront with them and they (the patients) were shocked when they became increasingly terminal. I went to a fertility specialist that had the most gawd-awful bedside manner (and I knew this going in after checking with other women) but I ended up with a baby! And his success rate was really the capstone on his reputation. I lucked out with a gynonc that was an excellent doctor and good bedside manner. But I would always go with the best doctoring skills before I would worry about bedside manner. And I may have to do that as my gyn onc is moving across country. Ouch.
  • Lisa13Q
    Lisa13Q Member Posts: 677
    My Perspective
    I read an article from a cancer patient once, and she discussed how irritated she became when people told her the truth, and how irritated she became when people sugar coated the truth, and how irritated she became when people tried to be kind, and how irritated she became when people were not very nice and on and on......Any cancer patient has the right to be irritated with their doctor at any time for any reason....this is the most difficult "stuff" to deal with....I think, what's most important is if the approach, or drama, or wording, bothered her, than she needs to discuss her feelings with her doctor about that....I can't imagine hearing those words, how terrifying.....perhaps, she wants a different approach in the future....as I have learned in the past few weeks, we are all different in how we want to fight this beast...and there is no right way or wrong way.....I have also learned that we can fight through anything, and any statements or predictions are always to be challenged.....there are no expiration dates and no psychics....the will to live is an amazingly strong force, directness can be awful for some and a gift for another....like charging dinosaurs or beautiful angels....I will pray for your friend for some peace...I think that is the most important thing....
  • Tina Brown
    Tina Brown Member Posts: 1,036 Member
    I agree with you Carlene
    I agree with you Carlene. I actually prefer plain speaking myself and I actually think the answer was very profound and reflected the prognosis about cancer. I think 99% of people diagnosed with a type of cancer will eventually succomb (sp?) to it eventually. It may be months it may be years but it is a sure thing that the cause of death would be cancer related.

    So if you don't want to know the answer don't ask the question. I admire the doctor for painting such an imaginative picture.

    Tina
  • Chemo_Princess
    Chemo_Princess Member Posts: 105
    Agree
    I agree with you Carlene. When I was diagnosed I told my doctor I did not want her to sugar coat anything, ever. She has been upfront and honest with me. I know I will never be cured. I have learned to deal with it. However, I do not believe 100% that cancer will be what kills me. Let's be realistic here; I could be hit by a bus, sucked up by a tornado, etc. Nobody knows when their time will come. I just hope when it's my turn I go fast and in my sleep....
    Natalie
  • pstur1
    pstur1 Member Posts: 37
    I couldn't agree with you more Carlene
    If I ask a direct question I want a direct answer. I actually think he was being kind by being blatant. Could he have expressed in other ways, sure but in the end it is what it is. I thought his metaphor was well spoken actually.

    I don't find your take odd in the slightest, don't ask a question if you don't want the answer would the lesson here for her, as you said.
  • LaundryQueen
    LaundryQueen Member Posts: 676

    Agree
    I agree with you Carlene. When I was diagnosed I told my doctor I did not want her to sugar coat anything, ever. She has been upfront and honest with me. I know I will never be cured. I have learned to deal with it. However, I do not believe 100% that cancer will be what kills me. Let's be realistic here; I could be hit by a bus, sucked up by a tornado, etc. Nobody knows when their time will come. I just hope when it's my turn I go fast and in my sleep....
    Natalie

    But no one knows anything for sure anyway
    I guess I am one of the one's guilty of resorting to statistics because there is no real answer to the question "will this disease kill me?" I agree with the "don't tell me if I don't ask" but the information is out there all over the Internet anyway.

    I think the internist was wrong in assuming that the patient had a 100% chance of dying from OVCA because that is absulutely not true. However, all that being said, MAYBE her husband (the oncologist) has a track record of 100% in killing his patients with chemo--that may be what the internist is basing her opinion on. In which case, the patient would be wise to find not only another internist, but also another oncologist.

    One thing I have learned is that I am going to believe what I want to believe--no matter what someone tells me. I would not have gotten angry if someone gave me the tsunami lecture, I would think "just watch me prove you wrong!" hahahahaha!

    LQ (still living in Lala Land)
  • Hissy_Fitz
    Hissy_Fitz Member Posts: 1,834

    But no one knows anything for sure anyway
    I guess I am one of the one's guilty of resorting to statistics because there is no real answer to the question "will this disease kill me?" I agree with the "don't tell me if I don't ask" but the information is out there all over the Internet anyway.

    I think the internist was wrong in assuming that the patient had a 100% chance of dying from OVCA because that is absulutely not true. However, all that being said, MAYBE her husband (the oncologist) has a track record of 100% in killing his patients with chemo--that may be what the internist is basing her opinion on. In which case, the patient would be wise to find not only another internist, but also another oncologist.

    One thing I have learned is that I am going to believe what I want to believe--no matter what someone tells me. I would not have gotten angry if someone gave me the tsunami lecture, I would think "just watch me prove you wrong!" hahahahaha!

    LQ (still living in Lala Land)

    LQ (and all).....I should
    LQ (and all).....I should have explained that the woman in question has recurred 4 times, including mets to the brain. It's been 5 years since her diagnosis. I think this probably explains a lot, as far as how the doctor answered her question. I doubt any doctor would be so pessimistic, otherwise.

    Carlene
  • jbeans888
    jbeans888 Member Posts: 313
    I agree with you. If you
    I agree with you. If you ask, then they should tell you honestly because that's the point of asking questions. Right?
  • Hissy_Fitz
    Hissy_Fitz Member Posts: 1,834
    The dynamics between the two
    The dynamics between the two boards are soooooo interesting. Exactly two other people, out of 13 responses, agreed with me, and one of them qualified her answer by adding that she thought the doctor "could have been more tactful."

    This is what one woman said:
    It's extremely irresponsible for the doctors to dish out grim forecast haphazardly at the risk of paralyzing their patients' psyche and making them feel helpless and out of control.

    I thought, wow....really? Since when is it "haphazard" to answer a direct question?

    Reminds of of something a therapist told my adolescent daughter once, regarding a specific complaint about her parents: you don't get to pour a bucket of crap over their heads, then complain because they stink.

    Carlene
  • The dynamics between the two
    The dynamics between the two boards are soooooo interesting. Exactly two other people, out of 13 responses, agreed with me, and one of them qualified her answer by adding that she thought the doctor "could have been more tactful."

    This is what one woman said:
    It's extremely irresponsible for the doctors to dish out grim forecast haphazardly at the risk of paralyzing their patients' psyche and making them feel helpless and out of control.

    I thought, wow....really? Since when is it "haphazard" to answer a direct question?

    Reminds of of something a therapist told my adolescent daughter once, regarding a specific complaint about her parents: you don't get to pour a bucket of crap over their heads, then complain because they stink.

    Carlene

    This comment has been removed by the Moderator
  • carolenk
    carolenk Member Posts: 907 Member

    The dynamics between the two
    The dynamics between the two boards are soooooo interesting. Exactly two other people, out of 13 responses, agreed with me, and one of them qualified her answer by adding that she thought the doctor "could have been more tactful."

    This is what one woman said:
    It's extremely irresponsible for the doctors to dish out grim forecast haphazardly at the risk of paralyzing their patients' psyche and making them feel helpless and out of control.

    I thought, wow....really? Since when is it "haphazard" to answer a direct question?

    Reminds of of something a therapist told my adolescent daughter once, regarding a specific complaint about her parents: you don't get to pour a bucket of crap over their heads, then complain because they stink.

    Carlene

    It isn't just about "the truth"
    I think there is no compulsory code of ethics for doctors to be brutally honest to patients. This scenario could be argued in a dozen different ways. I think it all boils down to kindness. Was the doctor right? Probably so. Was the doctor kind? Definitely NOT!

    If I was dealing with this patient nearing the end of her life as her primary care provider, I would not have answered the question directly at first. Rather I would have said, "what do you think?" because the patient was probably looking for hope rather than the harsh reality that she was smacked in the face with. The patient already has fears about dying from her cancer & may already suspect it's gonna kill her. This question--this patient--deserves a dialogue but there's no time for that.

    Most doctors have 15 minutes to see patients & no time to get into such a discussion. Do you really think it is right to take away EVERY shred of hope from someone? I think people should be allowed to come to the realization of their demise when they are ready. Maybe the internist assumed the patient was ready to hear "the truth."

    Sigh, I'm a holistic nurse & I am very aware of the mind-body connection. Who hasn't heard stories of people defying the odds & prolonging their life by sheer will? Now, the patient in question may succumb to her ideas sooner because she has no hope of survival.
  • Hissy_Fitz
    Hissy_Fitz Member Posts: 1,834
    carolenk said:

    It isn't just about "the truth"
    I think there is no compulsory code of ethics for doctors to be brutally honest to patients. This scenario could be argued in a dozen different ways. I think it all boils down to kindness. Was the doctor right? Probably so. Was the doctor kind? Definitely NOT!

    If I was dealing with this patient nearing the end of her life as her primary care provider, I would not have answered the question directly at first. Rather I would have said, "what do you think?" because the patient was probably looking for hope rather than the harsh reality that she was smacked in the face with. The patient already has fears about dying from her cancer & may already suspect it's gonna kill her. This question--this patient--deserves a dialogue but there's no time for that.

    Most doctors have 15 minutes to see patients & no time to get into such a discussion. Do you really think it is right to take away EVERY shred of hope from someone? I think people should be allowed to come to the realization of their demise when they are ready. Maybe the internist assumed the patient was ready to hear "the truth."

    Sigh, I'm a holistic nurse & I am very aware of the mind-body connection. Who hasn't heard stories of people defying the odds & prolonging their life by sheer will? Now, the patient in question may succumb to her ideas sooner because she has no hope of survival.

    I understand your POV,
    I understand your POV, Carole, but which type of doctor would you want?

    If I asked my doctor, "What does the future hold for someone like me?" and he answered my question with a question of his own ("What do you think?"), I would feel like he was patronizing me. How is a physician supposed to know who wants which answer?

    I am definitely going to ask my doctors about the ethics of this. I was perfectly okay with not telling my (late) husband that he had only a few months to live. (He already knew he had cancer.) His doctor, however, said, "We have to tell him." I don't know if that was just something he felt strongly about, or if there is a physican's code of ethics that addresses a terminal prognosis and whether it must/should it be conveyed to the patient.

    Carlene
  • Hissy_Fitz
    Hissy_Fitz Member Posts: 1,834
    carolenk said:

    It isn't just about "the truth"
    I think there is no compulsory code of ethics for doctors to be brutally honest to patients. This scenario could be argued in a dozen different ways. I think it all boils down to kindness. Was the doctor right? Probably so. Was the doctor kind? Definitely NOT!

    If I was dealing with this patient nearing the end of her life as her primary care provider, I would not have answered the question directly at first. Rather I would have said, "what do you think?" because the patient was probably looking for hope rather than the harsh reality that she was smacked in the face with. The patient already has fears about dying from her cancer & may already suspect it's gonna kill her. This question--this patient--deserves a dialogue but there's no time for that.

    Most doctors have 15 minutes to see patients & no time to get into such a discussion. Do you really think it is right to take away EVERY shred of hope from someone? I think people should be allowed to come to the realization of their demise when they are ready. Maybe the internist assumed the patient was ready to hear "the truth."

    Sigh, I'm a holistic nurse & I am very aware of the mind-body connection. Who hasn't heard stories of people defying the odds & prolonging their life by sheer will? Now, the patient in question may succumb to her ideas sooner because she has no hope of survival.

    I found an excellent
    I found an excellent paper:
    Honesty in Medicine
    Should Doctors Tell The Truth
    By Dr. James F. Drane
    Profesor Emeritus
    University of Edinboro Pennsyvania

    It touches on just about every aspect and every scenario, including the recent "Patient's Bill of Rights." If you have time and the inclination to read the whole thing, it can be found at:
    http://www.bioetica.uchile.cl/doc/honesty.htm#top6

    This is a cut-and-paste from "The Dying Patient" paragraph:

    No one could pretend to speak for every patient in every context but generally speaking, patients want to know the truth about their condition and doctors are unlikely to be correct when they judge this not to be the case. Some patients who are given a cancer diagnosis and a prognosis of death may use denial for a while and the bad news may have to be repeated, but the use of denial as a coping device does not mean that patients would prefer to be lied to or that truth is not important to them. Patients need the truth even when it tells them about their death. To live without confronting the inevitability of death is not to live in anything approaching a rational or moral way. It is wrong to assume that patients prefer irrationality and moral superficiality. A death notice is a shock and a pain and yet patients can derive benefit from being told the truth even about their own death.
  • carolenk
    carolenk Member Posts: 907 Member

    I understand your POV,
    I understand your POV, Carole, but which type of doctor would you want?

    If I asked my doctor, "What does the future hold for someone like me?" and he answered my question with a question of his own ("What do you think?"), I would feel like he was patronizing me. How is a physician supposed to know who wants which answer?

    I am definitely going to ask my doctors about the ethics of this. I was perfectly okay with not telling my (late) husband that he had only a few months to live. (He already knew he had cancer.) His doctor, however, said, "We have to tell him." I don't know if that was just something he felt strongly about, or if there is a physican's code of ethics that addresses a terminal prognosis and whether it must/should it be conveyed to the patient.

    Carlene

    Carlene: you missed my
    Carlene: you missed my point. My point was the question deserved a discussion--the way to open a discussion & feel out where the person is coming from is by asking "what do you think?" notice I used the word "first." I didn't say that was all the doctor should say.

    A good doctor might know this "communication technique" but ALL nurses are taught this. I'm a nursing instructor...lol!

    I still would rather have the kind doctor (all else being equal). Sometimes the only medicine left to give is kindness.

    Carolen

    Correction on preceding post: I meant to say the patient succumb to her disease not her ideas (durn iPhone!). Although one may succumb to their ideas just as well.
  • Radioactive34
    Radioactive34 Member Posts: 391 Member
    long response
    Some people really can't deal with the truth. I got the straight up from the first time they found the mass. The urgent care doctor was blunt, "You have a mass. It may be cancer." I thought that was such a defninitive pronouncement with just an ultrasound. Though that did prepare me for the whirlwind the next two weeks were. I was in surgery less than two weeks later.

    Between that urgent care visit and the regular GYN visit, I had 2 1/2 days. I did not know anything beyond, "I have a mass on my ovary." My initial searches left me with the impression that "Ok, you get chemo and at least 80-90% survive." I could do this...like a broken leg.

    The gyn tentatively called it dysgerminoma (sp?), but told me to wait until the oncologist atually had it typed before taking that as concrete. I had 7 days between that visit and the oncologist gyn. Initial searches were again the same. Then I stumbled on an article about tumor research.

    There was an interview with a doctor lamenting that they did not more information on ovarian cancer. He talked about how this kills a lot of women...and at that point I got a serious clue. I went past the regular search engines and seriously began looking at the medical findings. I was angry at the articles that gave a false impression.

    Since then, I am scared, depressed, and am gearing up for the literal fight of my life, but am happy to have a clearer picture. I do not do well with hlaf truths. War, it is for me.

    On the other hand....I had a cousin die of cancer a week and a half ago. They buried his ashes Saturday. I live states away and saw him about once every 2-3 years. I ran into his sister earlier this year. The doctors at that point, had said pallative care was the way to go. There was no more to be done. They did not tell my cousin. He was in a nursing home, thinking he was going in between treatments.

    Up until he got really sick he was happy and ambulatory. He went to lunch with his kids. The siblings took him on outings. He was clueless and happy. The family recounts a stress free man, who was just taking a break from the cancer treatments.

    R34
  • Hissy_Fitz
    Hissy_Fitz Member Posts: 1,834
    carolenk said:

    Carlene: you missed my
    Carlene: you missed my point. My point was the question deserved a discussion--the way to open a discussion & feel out where the person is coming from is by asking "what do you think?" notice I used the word "first." I didn't say that was all the doctor should say.

    A good doctor might know this "communication technique" but ALL nurses are taught this. I'm a nursing instructor...lol!

    I still would rather have the kind doctor (all else being equal). Sometimes the only medicine left to give is kindness.

    Carolen

    Correction on preceding post: I meant to say the patient succumb to her disease not her ideas (durn iPhone!). Although one may succumb to their ideas just as well.

    I think it deserves a
    I think it deserves a discussion, too. And I have no way of knowing how much time the doctor we have been talking about devoted to this particular question. Maybe a little, maybe a lot. I am delighted to have learned something here. If my doctor ever asks me what I think, I will be more understanding of why he might be answering a question with a question (something that, in general, makes me crazy).

    The paper I cited mentioned this:
    The code of the American Nurses Association states: "Clients have a moral right..to be given accurate information." It urges nurses to avoid false claims and deception.

    Assuming the author's information was accurate, how would you negotiate that particular minefield? The delicate balance betweeen a direct question, where full disclosure might upset the patient, and a nurse's professional obligation? (Not necessarily the exchange between thiws particular patient and her doctor, but in general.)

    I took an ethics course in college and this kind of discussion is something I LOVE!

    Carlene
  • kayandok
    kayandok Member Posts: 1,202 Member
    Great thread!
    Painting a picture of rain and tsunami, I suspect was a doctor trying to gently tell the patient they were going to die eventually. Keep in mind that tsunamis are RARE!. I think he was a kind doctor, given the situation she was in. When a doctor gives a time frame, that actually feels like a death sentence, and I have mixed feelings about that. But, there are times when a patient is dying, that information could be really helpful for the family to hear. With ovarian cancer, sometimes patients go down hill really fast as we all know too well.

    I think if we do ask questons, we should always be prepared for the "truth". Some doctors just happen to be better at telling the truth with a dose of hope than others, it seems.

    I really like the words in the conclusion of the article (good job, finding that BTW!.) He says, "Finally, to tell the truth is not to deny hope. Hope and truth and even friendship and love are all part of an ethics of caring to the end." I want HIM for my doctor.

    I have thought a lot about this issue and having watched the way all of my doctors (two in the States and one in Japan) handle information has been facsinating. All of them have been very honest, but some better with handling the timing, hope, love and freindship thing. Not an easy job, when you have so many patients.

    k
  • Hissy_Fitz
    Hissy_Fitz Member Posts: 1,834

    long response
    Some people really can't deal with the truth. I got the straight up from the first time they found the mass. The urgent care doctor was blunt, "You have a mass. It may be cancer." I thought that was such a defninitive pronouncement with just an ultrasound. Though that did prepare me for the whirlwind the next two weeks were. I was in surgery less than two weeks later.

    Between that urgent care visit and the regular GYN visit, I had 2 1/2 days. I did not know anything beyond, "I have a mass on my ovary." My initial searches left me with the impression that "Ok, you get chemo and at least 80-90% survive." I could do this...like a broken leg.

    The gyn tentatively called it dysgerminoma (sp?), but told me to wait until the oncologist atually had it typed before taking that as concrete. I had 7 days between that visit and the oncologist gyn. Initial searches were again the same. Then I stumbled on an article about tumor research.

    There was an interview with a doctor lamenting that they did not more information on ovarian cancer. He talked about how this kills a lot of women...and at that point I got a serious clue. I went past the regular search engines and seriously began looking at the medical findings. I was angry at the articles that gave a false impression.

    Since then, I am scared, depressed, and am gearing up for the literal fight of my life, but am happy to have a clearer picture. I do not do well with hlaf truths. War, it is for me.

    On the other hand....I had a cousin die of cancer a week and a half ago. They buried his ashes Saturday. I live states away and saw him about once every 2-3 years. I ran into his sister earlier this year. The doctors at that point, had said pallative care was the way to go. There was no more to be done. They did not tell my cousin. He was in a nursing home, thinking he was going in between treatments.

    Up until he got really sick he was happy and ambulatory. He went to lunch with his kids. The siblings took him on outings. He was clueless and happy. The family recounts a stress free man, who was just taking a break from the cancer treatments.

    R34

    R34....
    My dctor sent me to

    R34....

    My dctor sent me to have my gallbladder checked, via sonogram. Then he called me, from his cell phone because he was heading out of town for a long weekend. He didn't even bother with terms like "mass" or "cyst", or "might be cancer." He just said, "It's not your gallbladder. It looks like you have ovarian cancer. I want you to call the office and get the girls to make an appointment for you with Mark Messing. You've probably had this over a year, and unfortunately, the survival rate is less than 30 percent." Nice, huh?

    Nevertheless, when I met with the gyn/oncologist, one of the first things I told him was that I wanted him to promise he would always tell me the whole truth.

    Carlene