Doctor's Dilemma

Should doctors tell patients the truth? Indeed, asks Dr. Charles C. Lund in the current Annals of Internal Medicine, "Is it possible to convey the 'truth' about a serious matter to a patient?" The Boston cancer specialist's own answer: "Blunt 'truth' is not good [but] avoidance of the 'truth' may be as bad."

If a doctor abruptly announces, "This is cancer," his patients will react in many ways. Eight out of ten, says Dr. Lund, might consent to surgery but "of these half might never forgive the doctor for his brutality." One patient out of ten might "believe erroneously that cancer is never cured and therefore decide to have no treatment. The other might be so upset mentally that [he] leaves the doctor and goes to a charlatan in whose hands all hope of cure will be lost."

Dr. Lund's advice: at the start the doctor "should avoid the words carcinoma or cancer." He should use loose, non-frightening words.

But if the doctor cheerily avoids the word "cancer"? Again, eight out of ten might consent to surgery; but some, if their cancers recur, "will blame the doctor by stating that the operation was not worthwhile" and say that they would never have consented if they had known the true nature of their disease. And two might refuse surgery until too late because they had not been warned clearly of their condition.

After an operation, Dr. Lund thinks, the patient should gently but firmly be told what has been found and whether he will live. "Dying patients usually have a fairly good insight into their condition and the shock of confirming this belief is not great. . . ."

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