When should a Doctor be frank?

Ladies' Mirror, Volume 5, Issue 3, 1 September 1926, Page 33

When should a Doctor be frank?

•By A Physician

And the only possible answer is—that it all depends! Depends on what? Well, mainly on the personality of the patient. If, for instance, a doctor finds that a patient is suffering from a deadly disease, which he knows must be fatal within a comparatively short time, only his profound knowledge of human nature can tell him whether in that particular case it will be wiser to tell the calm truth, or whether it is best to build up some sort of hope. After all, no one is infallible and when hope is gone, all is gone. If refusal to tell the truth means that a man delays putting his affairs in order —if he has made no provision for his dependents or has made no will, then it is usually possible to drop a hint, which, while not destroying hope altogether, is sufficiently serious to draw toe man's attention to the fact that life may not always continue as it is continuing at the present moment. In other cases, even a hint that there is anything seriously wrong is quite sufficient to throw a man or woman completely off their balance, and to produce such a state of mind that any tragedy may he the outcome of it. Some patients beg to know the worst in a calm, philosophic frame of mind, and with them it is really only fair to he frank, although, as 1 have already said, no one is infallible, and with all the skill and careful investigation in the world, Nature has a way occasionally of playing a pleasant little trick and ol producing some kind of cure in a case to which there seemed to he only one end. ¥ always remember a case in which -*■ this occurred in my own experience. A woman had been operated upon for cancer, and alter the operation was begun, things were found to be in such a hopeless state that regretfully and sorrowfully the wound was closed again without anything having been done, as the growth had spread beyond the belief or hope of cure. Nothing was said to the woman, who went home, as we all thought, to die within a month or so. To our astonishment she came round about a year later to report how well she was, and for five years running on the anniversary of the operation, she calls or telephones to say that she is still very well, thank you. Now the surgeon was one of highest repute and the growth had been sectioned and pronounced malignant by one of the most reliable pathologists in London, and yet there was the woman still alive and well at least five years later. Of course, these happy mistakes do not often occur, hut it is a very old and true saying that while there is life there is hope, and as any doctor will tell you. it is an idle struggle which one can put up against disease and death unless the will of the patient is with you. No ill tierson is entirely normal and every

little inflection of the voice, every glance and every word is noticed and turned to the worst or best according to the mental and moral outlook of the patient and of his or her relatives. T remember a case in which a woman was ill with pneumonia and had safely passed the crisis, and yet somehow did not make any real progress. She simply seemed to have lost every scrap of desire to live, and the physician in charge was at his wits’ end, well knowing what a hopeless fight it was going to be without her co-operation. Previous to her illness she had been madly fond of clothes, but now the prettiest boudoir cap or bed-jacket roused no faint trace of interest. Then suddenly one morning she asked a relative who had called to see her what the shops were showing for the spring fashions, and from that moment the doctor breathed again knowing that she would now take the steps forward to regain her normal health. There arc not only the serious questions of life and death which a doctor has to decide. 1 here are also the questions when he has to decide whether he shall tell the brutal, unvarnished truth to a patient, and chance losing her for ever. Shaltohc tell the confirmed invalid who has no sign or trace of organic disease that she is merely a selfish neurotic, who would he all the better for a day’s honest work ? Shall he he frank with the childless married woman who has a hundred and one complaints and tell her that four or five children would cure her more quickly than anything else? Shall he tell the woman of fourteen stone who consults him about the latest treatment for obesity, that she is eating like a glutton, and that if she reduced her food and drink by half, she would improve forthwith? \ And the answer to them all is, that it all depends! Depends on the struggle between his kindness of heart and his love of truth, and incidentally— on the state of his bank balance ! And then there is the heartbreaking problem, which occasionally arises when a doctor has known two families all his life. He has watched the daughter grow up through childhood to womanhood, and now the time for her engagement has come. And the young man whom she has chosen for her fiancee is a son of another family whom also the doctor has known from boyhood up. And he also knows that he is suffering from a form of venereal disease. Should the doctor tell the girl the unhappiness she is facing, or should he warn the young man of the action he proposes to take if he persists in the engagement? These arc some of the problems which no text-book on ethics ever yet cleared up, and, as I said, it all depends 1