Hope versus Reality?

Honesty, truthfulness and patient autonomy were instilled to us by our medical education.

When I was a younger oncologist, I was very passionate about needing to tell everything about the condition to the patient and their relatives. I tell them that it is my job and responsibility to be straightforward and honest no matter how painful the truth is. I rationalized that the patient HAS to know in order that he may be prepared for the inevitable and be able to finish unfinished business. However, as I encounter more patients, I am noticing that there are some subsets of patients who are not quite ready to hear the bad news. There are patients who have left me because they were not ready to hear the truth no matter how compassionately it was delivered. They were just not yet ready for it.

Everyday I am faced with the dilemma to be straightforward and honest no matter what or should I play along and keep patients’ hope up. Perhaps one might say that it’s a simple question. The doctor must always keep the patient’s hope up. Not quite because there are implications of this action.

On one hand, there are patients who, when told of their prognosis, opt not to undergo active treatment. Even if I subscribe to the notion that it is the patient’s right to refuse treatment and this must be respected, there is always the voice that keeps on asking “What if?”. On the other hand, there are patients who would do anything and everything, even sell their last piece of property, for a slim chance of improvement. It’s like I’m always walking on a tightrope. I must carefully balance delivering the truth without shattering the patient’s hopes.

Which one would you prefer? Hope or Reality? I’d like to hear what you think.

Denky Dela Rosa

About Denky Dela Rosa

I am a Doctor of Medicine. My specialty is Internal Medicine (Doctor for adults) with subspecialty in Medical Oncology (Cancer). I am also a Certified Holistic Health Coach graduating from the Institute of Integrative Nutrition, New York City

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