Painful Diagnosis: Doctors Must Be Frank, Even When The News Is Bad

doctor-and-patientA troubling case before the state Supreme Court asks if parents can sue their doctor for not telling them about a fetus’ birth defects. An auxiliary issue is whether doctors have an obligation to disclose to patients the negative outcome of an examination or test. Presumably, ethics would demand such an accounting, but we’re disturbed that not all doctors share that view.

In March, the Alzheimer’s Association released a study that showed 45 percent of people with the degenerative brain disease had not been told by their doctors that they had it. When researchers asked why they had withheld the information, doctors said they didn’t have time and resources to explain the diagnosis, and they didn’t want to cause emotional distress to patients who were already sick.

That study compared the disclosure rates of Alzheimer’s patients and those with cancer. Some 90 percent of patients with cancer and cardiovascular disease were told of their diagnosis, but it’s troubling that 10 percent were not. In another study, just 37 percent of doctors treating terminally ill patients told them honestly how much longer they could expect to live.

In the “wrongful life” case argued May 6 before Pennsylvania justices, the parents allege that their doctor did not share prenatal test results that would have warned them that their child would likely be born with a genetic disease that would result in prolonged suffering and early death. The doctors have not acknowledged or denied the accusation, and the case hangs on whether the couple can sue under these specific circumstances. Right now, a 27-year-old law suggests that they can’t.

Conveying bad news is just one part of an extraordinarily challenging profession; an oncologist will do it 20,000 times over the course of a career. But whether the withholding of information by physicians is accidental or intentional, it is wrong, even with benevolent intent. Telling someone that he has Alzheimer’s, or that her baby will have a birth defect, is difficult and seems a contradiction of the Hippocratic edict to do no harm.

But silence harms, too, and deprives patients of what they seek when they go to a doctor: a frank diagnosis and a treatment plan.

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