How to disclose about an end stage disease
After taking proper history, physical examination and laboratory tests, if I find my patient suffering from some cancer or serious disease, how should I ventilate that to the patient or his/her relatives. Many a time, a physician faces this situation. There are various ways to ventilate the news which depends upon the nature of the disease, education level, economic status, social background, mental make up, culture and religion of the patient. While I teach to my clinical students, often I tell them two very important words, one is sympathy and the other one is empathy. Listen to the patient with sympathy and treat them with empathy. To be a good doctor and for a better management and outcome, this is very much essential. Other thing is communication skill. It is the first important step to build up good and effective relationship with a doctor and the patient. It is an art and should be acquired from the very beginning. Communication and interpersonal relationship have become a core focus of medical education in the USA. Their students need to appear in exam on that issue. If the diagnosis of the patient is cancer or HIV or something very serious, don't say that spontaneously straight way. They advise is to reassess the patient, repeat the lab tests, confirm the diagnosis, if needed consult with seniors and take some time. Make an appointment with the patient, his/her parents, nearest relatives or neighbour on some other day and sit with them, talk to them in a congenial atmosphere and try to understand the overall situation and share your experience of similar patients; then tell the truth with positive attitude. Those who bring the bad news, must do it in an empathetic way and allow dialogue back and forth and answer the questions honestly. It helps to have X-rays and graphics to show the cancer patients what is going on and break it down into laymen's terms. They may have many questions, such as the time frame left, if they are experiencing pain, if there are any other new medical cures or experimental drugs and such. The doctor needs to be truthful without giving false hope. The patient's emotion will be filed with thoughts of divine intervention, anger, denial, depression, resignation, and hopefully eventual acceptance. Different patients react differently to the news of carrying a terminal illness like cancer. In general, almost all patients go through various stages of acceptance when an end stage disease has been diagnosed. The first stage is disbelief. Most people are shocked that it could happen to them, there is extreme anxiety, especially about the unknown. Shock, despair and anger are common. There is also guilt that perhaps one has done something wrong to receive such a diagnosis. Some individuals find it humorous; others become helpless and often start to bargain. This first stage is usually short lived and usually lasts from a few days to a few weeks. The second stage is depression which is usually a reaction to the diagnosis. The depression is mild to moderate in intensity and needs family support. Duration of depression often can last several weeks but soon it fades and one goes into the final stage of acceptance. So the way of disclosing the fact is very important and that reflects the knowledge, attitude, behaviour, sympathy and empathy of the doctor towards the patient. Please approach this issue carefully. How we deal with it will mean a lot to the person we are relaying the news to. Many a time we cannot cure the disease, but definitely we can reduce the mental suffering of the patients and relatives by our cordial and sympathetic approach.
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