Here’s the scenario. The patient, usually a child or elderly person, becomes ill.

The doctor does the usual evaluation and testing, and arrives at a diagnosis.

Then, the patient’s family enters the scene and asks that the patient not be informed of the diagnosis.

This request is usually made because the family feels the patient will not be able to cope with the diagnosis, will decompensate and only become upset.

This is often the case when the disease is a serious one, with a predictably rapid fatality.

After all, why burden someone who has a serious disease with all the morbid details when they only have a short while to live anyway?

Why not just conceal the future problems and let the patient proceed blissfully to the end?

Now comes the interesting part.

In that very same situation, the patient will usually tell the doctor that if there is any bad news about his or her medical condition, the patient would appreciate it if the doctor would not tell the family about it.

After all, it’s the patient’s problem, so why burden the family?

Why put them through the agony of a serious illness and all the associated worry?

Now, what’s the doctor to do?

Believe me, it’s not fun being caught in the middle.

It’s hard to have a happy ending to this story.

If the doctor listens to the patient’s family and the patient eventually finds out, as he or she will, then the patient is angry and has every right to be.

If the doctor listens to the patient and the family eventually finds out, as they will, then the family is angry.

The difference is that the family does not have the same right to be angry as the patient.

The all-important patient-physician relationship dictates that the doctor’s first and foremost obligation is to the patient, and to the patient’s family only if the patient is incompetent because of age or mental and intellectual abilities.

No matter, even if the family has no right to be angry, they still will be and the doctor does not need an angry family to deal with along with a sick patient.

The correct solution to this problem lies in establishing the correct relationship with both the patient and the family.

The motives of both are honest and pure.

If the physician honors both groups’ wishes and tells each about the problem but doesn’t tell one that the other knows, then both parties carry a terrible burden without the ability to share the load and comfort each other.

It makes no sense.

Better, the doctor should sit down with everyone, either individually, together or both, and explain why it is better for the patient and his or her support groups to know the nature of the problem and develop methods to deal with the issues.

In that way, mutual understanding and support can be attained.

Of course, in most cases, the patient has the final say in the matter and his or her wishes must prevail.

But, with the proper relationship between the patient, doctor and family, much can be gained from open discussions.

Dr. Michael M. Warren is Ashbel Smith professor of surgery at University of Texas Medical Branch Division of Urology. Write him at michael.warren@galvnews.com.

(3) comments

PD Hyatt

You are absolutely correct as the patient should be told the truth even if the family does not agree.... After all they deserve to know what it going on with them so that they can prepare to meet their maker and to say their good-byes to their loved ones....

George Croix

The patient's confidentiallity and/or request for handling of their medical info is protected by law, not the families desire to know.
If the patient doesn't want the family told, they should not be.
On the flip side, the family, unless a spouse, or in the absence of one if one or more others have medical power of attorney for that patient and the patient is unresponsive and unable to be informed, has no legal business finding out about the diagnosis before the patient, unless the patient has given permission for it.

Getting a medical power of attorney is cheap and fast. Do so while one can still be given and signed for.

Michael Warren

A reader sent me an e-mail regarding my comment about age as a factor in telling the patient. She felt being old does not necessarily mean incompetent. My own age makes me agree with her completely. What i really meant to say was than the patient may be too YOUNG to deal with the information. Age works both ways..

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