The nurse told me that a new patient was referred to me. The biopsy result confirming a diagnosis of cancer came out only yesterday. I went over the patient’s record then asked the nurse “Does the patient already know?”.
When I was a student, we were taught that it is unethical to discuss a patient’s diagnosis with anyone other than with the patient himself. Doctors are expected to be straightforward with the patient. It was considered unacceptable to discuss the diagnosis first with the relatives.
When I became a doctor, I noticed exactly the opposite. Relatives often do not want the doctor to disclose the diagnosis to the patient. Relatives do not discuss the situation with nor around the patient. Health care workers are instructed to keep silent about the diagnosis. Everybody knows except the patient. So goes the conspiracy of silence.
What the relatives say
The most common reasons why relatives don’t want patients to know is because they are afraid that the patient will worry, become sad or depressed and they fear that this will contribute to hastening the patient’s deterioration or demise.
This reaction is very common not only in the Philippines but in every culture. This is more prominent, however, among Asians especially the Chinese and Japanese.
Factors That Influence Truth Telling
I have also observed that the degree of education plays some role. More educated patients tend to be more open about being told the truth and would demand such to give them the opportunity to prepare and participate in decision-making.
Other factors include family conflicts and our own inability to come to terms with the situation. A diagnosis of a life-changing illness affects not only the patient but the entire family. Family members also go through emotions such as denial, fear, anxiety and all sorts of emotions that patients go through. Sometimes, patients unknowingly project these emotions into the patient and we fail to distinguish our own thoughts and emotions from those of the patient.
(These are not meant to cast judgement but to simply point out my observations)
And of course, socio-cultural factors play a very crucial role. The family is seen as a cohesive unit that is charged with the authority to take care of the needs of its members.
A Doctor’s Perspective
In my experience, I have not encountered a patient whose condition literally deteriorated because of having been told his diagnosis and prognosis. It’s true that some patients tend to worry, become sad and others go into depression but these are normal emotions for patients to go through upon knowing that they are diagnosed with a potentially life-changing condition. These are normal human reactions to disease. Admittedly, there are patients who may get into severe depression but these cases are rare and can be managed.
Stages for Growth
There are stages of growth in being diagnosed with an illness. Patients must be allowed some time to be sad, to think, to worry, to be anxious. We must not deprive them of this opportunity because this is possibly a springboard to becoming stronger and a better human being.
We are like glass. Glass has to go through intense heat to be molded into a beautiful piece of art. Not allowing the patient to experience these emotions is like leaving the glass alone because we do not want it to go through the heat. Not allowing the patient to go through these emotions may hinder the patient from learning and thus growing in the process.