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Path: utzoo!watmath!clyde!cbosgd!ihnp4!ihuxe!chrz
From: chrz@ihuxe.UUCP (p. chrzanowski)
Newsgroups: net.med
Subject: Re: Cancer and physician arrogance
Message-ID: <1221@ihuxe.UUCP>
Date: Mon, 23-Sep-85 11:59:53 EDT
Article-I.D.: ihuxe.1221
Posted: Mon Sep 23 11:59:53 1985
Date-Received: Tue, 24-Sep-85 03:40:10 EDT
Distribution: net
Organization: AT&T Bell Laboratories
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> Having discussed this with several M.D.s, I have been told that I
> can probably expect more metastases, more remissions, but not long
> term survival.
> I have had to shop for M.D.s, and not just for competence.
> Altogether too many have felt that info about MY body, which I paid
> for, belongs to THE DOCTOR, not to ME!!  I'd guess full disclosure
> is more of a problem with serious illnesses; some M.D.s apparently have
> the opinion that it is their right to decide if the patient can handle 
> really bad news.

>> I'm sorry about your situation, and I very much acknowledge the
>> existence of arrogant physicians.  However, your description of the advice
>> given you bears more resmeblence to brutal honesty than arrogance.  Many
>> oncologists take the tack: prepare for the worst, hope for the best -- not
>> bad psycological defense in a speciality where almost half of your patients
>> die within 5 years.
>> In the meantime, there are many On-line retrieval services that list
>> experimental protocols:  Index Medicus and GTE/MINET Drug Evaluations.  These
>> are by no means user friendly (the systems are user-friendly,the pharmacology
>> is what is so hostile.)

I don't believe that there is such a thing as "brutal honesty" in this
regard.  The state of cancer treatment is such that experts often disagree
as to the type of treatment that would be best.  The fine line between
curative and palliative treatment further confuses matters and multiplies
options.  The point is: it is impossible for me to decide what treatments
(if any) I want unless I have access to complete and accurate info.

My mother died of cancer.  She was constantly told she was getting
better so of course she chose to continue chemo. She was scheduled to
begin yet another course of chemo the day after she died.

I'd sure rather have complete, accurate data delivered coldly than
managed data delivered sympathetically.  I also need access to
primary data (CAT scan reports, etc.) since (1) this provides
me with more complete info, (2) makes it easier for me to consult
another M.D. when I wish to, and (3) eliminates any need to
trust the doctor not to fudge the data.  BTW, I'd guess most
cancer patients are quite aware of the seriousness of the illness,
and so managing the data (reporting good news but suppressing or
downplaying the significance of bad) may increase rather than
decrease the person's fear ("it must be terrifyingly bad if
they can't even tell me").

The patients responsibility in this is (1) to make one's wants
clearly known to health care providers, and (2) to continue
behaving in a responsible fashion if one wishes to continue to
enjoy the status of "responsible adult".

Yes it is arrogant of physicians and health institutions to deny
me information about my body that I paid for.  The strategy of
"expect the worst, hope for the best" makes sense, though.


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