CallaFirestormBW
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quote:
Lets imagine that you are a medical specialist and you discovered an inoperable cancer in a patient which gave the patient only a short time to live. How would you break this bad news to both patient and next of kin? Under what circumstances would you deviate from the raw truth in any situation mundane or kink?
I am actually -in- this exact situation, on occasion (due to my work at a large cancer center). I tell the truth, however, there are ways to express things that are less traumatic, and ways to do so that can be more traumatic. The key to being forthright without being crass or "blunt" (as in 'just use a sledgehammer, why don't you?") is to choose your words with the idea of the impact they might have on the individuals, and choosing your pacing in a way that allows people to process what you're saying. I think, in general, I always deviate from the "raw" truth, in that I tend to prepare the truth like sushi -- into smaller, more palatable, and carefully prepared bites, and with appropriate accompaniments to deal with the complicated 'flavor' of the information. It is still 'raw'... but often much easier to take.
Bad example that I have actually -seen- (complete with -very- poor planning for how to get -out- of the mess often created, while still helping the patient):
quote:
"Well. Hey there Mr. and Mrs., X. Hope you're comfortable at the hotel. So, we've reviewed your scans. I know you were hoping for surgery, but your scans show that your tumor is in a very difficult location, and your baseline tests are not amenable to surgery and indicate that you've progressed far enough that we would likely not be able to schedule you for surgery before you succumb to the progress of your illness, so I'm afraid I won't be able to help you. I'll have the chaplain check on you later."
So why is this a bad example? It wasn't rude, it wasn't dishonest, and the doctor seemed to have wanted to connect with the patient... so why, IMO, isn't this a good example of how to communicate such bad news honestly? Well, the "connection" is irrelevant -- a meaningless connection without substance or true bonding between the individuals. This isn't necessarily a -bad- thing... but it gives a veneer of 'falseness' to the whole situation. Then, the pacing rushed right into the bad news and abruptly into the failed opportunity with no time to process the experience.
My preference is preceded by good planning, like fully explaining the process to the patient when I saw them earlier, as well as what our test result requirements are to proceed with the study, and like having a social worker or chaplain standing by waiting for me to bring them in... but NOT with me in the room for the conversation. The discussion follows:
quote:
"Good morning Mr. and Mrs. X. Thank you for your patience.(not a lot of 'connection' -- but I am sensitive to one of the things that the patient -is- probably edgy about... how long xhe had to wait to see me--it is sensitive, but is honest about the fact that I am here in my 'professional' aspect, not as a friend or social contact)
I've had an opportunity to go over your test results, and I'd like to go over them with you." (this lets them know you're going to talk about what they're afraid of or hope for) We reviewed X test. As I explained to you at your last appointment, we require Z in order to be able to schedule a patient for surgery. As you can see here, your tests show that you are at P. It takes between N and N weeks to go from P to Z. (take a moment and look at them, and see whether they're following the conversation. When they nod or otherwise indicate that they understand, you move on)
Z is the minimum that we need in order to be able to plan surgery, so we will not be able to plan to operate until you reach Z. (I don't presume that -any- patient is terminal until they die. I've seen way too many cases where patients either died long before anyone expected them to, or live -well- beyond their 'death sentence'... so I don't sentence anyone... if they get to Z, they get scheduled for surgery... if they can last that long, and get to Z, they have a chance. Who am I to take that away through my pre-disposed negativity.) There are a few options while we wait. L, F, and R are your best options, in my opinion, at this point. (again, a brief pause to give them time to assimilate. Providing the viable options lets the patient know the reality of hir situation, without stealing any hope xhe might be able to retain, or any desire to fight xhe may still have, but is completely forthright about what the actual possibilities are for the patient) I will do anything I am able to help facilitate your decision. May I bring in someone to help you evaluate your choices? (at this point, if they say "yes", I can bring in the social worker or chaplain, and if they say "no", then I'll excuse myself and leave them my card (not the chaplains or social worker's) and let them know if they need some help, I'll facilitate getting it for them.)
I hope this actually answers the question (if not, blame it on a really bad spastic day and too many meds)
Dame Calla
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Said to me recently: "Look, I know you're the "voice of reason"... but dammit, I LIKE being unreasonable!!!!"
"Your mind is more interested in the challenge of becoming than the challenge of doing." Jon Benson, Bodybuilder/Trainer
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RE: The Truth, The Whole Truth And Nothing But The Truth - 
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