Relay-Version: version B 2.10 5/3/83; site utzoo.UUCP Posting-Version: version B 2.10.2 9/18/84 exptools; site ihuxe.UUCP Path: utzoo!watmath!clyde!cbosgd!ihnp4!ihuxe!chrz From: chrz@ihuxe.UUCP (p. chrzanowski) Newsgroups: net.med Subject: More on cancer and physician arrogance Message-ID: <1224@ihuxe.UUCP> Date: Thu, 3-Oct-85 13:45:24 EDT Article-I.D.: ihuxe.1224 Posted: Thu Oct 3 13:45:24 1985 Date-Received: Fri, 4-Oct-85 05:09:05 EDT Distribution: net Organization: AT&T Bell Laboratories Lines: 70 *** REPLACE THIS LINE WITH YOUR ??? *** > Having discussed this with several M.D.s, I have been told that I > can probably expect more metastases, more remissions, but > probably 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. > > 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 appreciate getting email on this subject, yet I think this response illustrates the problem: >> I am sorry to hear of your plight. >> There is no general approach of what to tell the patient when >> that works in all cases. Much of the art of medicine is involved >> with knowing your patient well enough to judge what the patient >> wants to know and is capable of knowing. What is good for you >> might cause another patient to go into a depressive state. >> It is not that physicians have the "right" to decide what to >> tell the patient, but that they have the "responsibility" for >> doing the best for each individual. My personal approach is >> more frank that most physicians, but I try to have the patient >> ask me for the information rather than forcing it on them. If >> there are responsible family members, I always share the full prognosis >> with them, never denying hope, since we really can't be sure what >> will happen in every case and have no right to make certain predictions. >> Then, with the family we decide how much the patient should be told. >> Most physicians will put the best face they can on the patient's >> prognosis, but ... What problem? 1) My family and the physician will decide for me what I should be told ?? This might be appropriate for a child, but not for an adult. Only if I am unconscious or otherwise not responsible for myself do I expect next of kin to make medical decisions for me. Also, this places a heavy and unnecessary burden on one's family: It hard enough to choose treatment options for oneself, but think of how much harder it must be to decide for another. 2) He seems concerned that I might " go into a depressive state". Well, yes, a diagnosis of cancer might be depressing, might even ruin your whole day, etc.: but so long as my behavior remains responsible, resposibility for my mental state rests with me, not with some physician (who may not even have any training psychology or psychiatry). Should a diagnosis of cancer cause me to no longer be regarded as a responsible adult ? How many physicians would like to be "protected" from the truth about their own illness? - or is that (in some way) different? There are many unpleasant aspects to having cancer that cannot (at this time) be changed -- but physician arrogance is not one of them. Brought to you by Super Global Mega Corp .com