Saying it like it is or dashing a patient's hopes? Cancer patient told to prepare for death

 

Picture: Daily News

 

A video posted on Facebook showed a doctor at Kluay Nam Thai Hospital telling a cancer patient there was no hope. 

 

Netizens complained that the consultant was unnecessarily abrupt and dashing the woman's hopes. She looked resigned to her fate in a wheelchair as her relatives filmed. 

 

Tens of thousands of Thais shared the video - up to 50,000 today. 

 

The woman - suffering from the complications of liver cancer - was told that she won't die today - but she has two years at the outside. 

 

She is told: "Get ready to say goodbye to your children - you can't be cured". 

 

The footage sparked a debate online between brutal honesty and giving hope. 

 

It appeared on the page of Sunee Kaewtangsin. 

 

 -- © Copyright Thai Visa News 2019-02-14

 

 

All that I would want is pain relief if necessary, chemo only seems to prolong life without regard to the quality.

I put forward my view concerning me only, a more youthful person should make their own decisions.

The Doctor May be blunt but should she lie ?

Sorry i disagree with people getting upset when a doctor tells the truth.

Doctors were telling me and my wife 8 months to 1 year and you will be walking again.

My wife got angry with me when i told them BS, my spinal cord is broken and i know i will never walk again.

Only 1 doctor told the truth his words were....you can only look forward to a wheelchair nothing more, and i thanked him for being truthful, the others were telling me what they thought i wanted to hear.

I suppose it depends on what you are diagnosed with and if even alternatives such as other treatments have been deemed useless then let me die in peace and for the pain if there is any as much morphine as my my body can take.

Sent from my CMR-AL19 using Thailand Forum - Thaivisa mobile app

In my experience the patient took the news bravely and stoically, Thais often seem to, I've met three who told me they had little time to live, 2 were suffering from liver cancer, and they were right.

I think the consultant had good intentions, it seems a previous doctor hadn't been straight with the family, still her manner of delivery was somewhat abrupt. She could have adopted a softer tone. Perhaps she was overworked and tired.

6 minutes ago, colinneil said:

Sorry i disagree with people getting upset when a doctor tells the truth.

Doctors were telling me and my wife 8 months to 1 year and you will be walking again.

My wife got angry with me when i told them BS, my spinal cord is broken and i know i will never walk again.

Only 1 doctor told the truth his words were....you can only look forward to a wheelchair nothing more, and i thanked him for being truthful, the others were telling me what they thought i wanted to hear.

I think the doctor is right by telling the truth. Lying should not be done by doctors.

Friend in UK has just had surgery to remove some bits and tumors and further tests showed stage 4 cancer.

They were told straight away what to expect so are trying to fit what time is left with things they always wanted to do.

For me I would like upfront news. 

If there is one thing I've learnt about Thais in my time here - it's that they hate direct and up front conversations. Personally, I'd rather hear it straight up, so I'm not uncertain about it all. Most Thais would seemingly rather hear a "mai pen rai" and then cling to false hope that it will all be okay

55 minutes ago, webfact said:

Netizens complained that the consultant was unnecessarily abrupt and dashing the woman's hopes. She looked resigned to her fate in a wheelchair as her relatives filmed. 

Netizens-the lowest common denominator, where intelligent thought is concerned. 

57 minutes ago, webfact said:

The footage sparked a debate online between brutal honesty and giving hope. 

"and giving hope"

 

You mean lying.

I have been working with a lot of dying humans - they all knew.

It is not simply telling the truth or lying - there is a third way: withholding the truth until it is requested, and there is a difference between offering a fatal truth - or force it on someone

Patients sometimes are not ready to hear the truth. And you don't know. Then it could be a good idea to start slowly, giving them a piece of truth that would make them ask for more or just the full truth. If they don't ask I'd leave it this way. May be next time they will be ready. I don't think it is a good idea to force the truth on someone who does not want to know. But always be ready to tell the truth when it is wanted. If you want to find out you could start with a question "what do you think how your ailment will go on?" 

If I'm dying, then TELL ME!  Don't give me "well, maybe" b.s.  I'm a big boy who has had one hell of a life.  Trust me, I can handle it.  Probably a lot better than my family could. 

 

7 minutes ago, sweatalot said:

Patients sometimes are not ready to hear the truth. And you don't know. Then it could be a good idea to start slowly, giving them a piece of truth that would make them ask for more or just the full truth.

Absolute rubbish. It is the doctor's job to tell them what they need to know, not what they want to hear and then rely on them asking the right questions to get the right answer. 

"The footage sparked a debate online between brutal honesty and giving hope." 

 

Right!!! Denial is a much better course of treatment.

 

If you know you have a limited time to live, You stop taking life for granted. You have the opportunity of being with your loved ones and living each moment as though time were the most precious gift. I worked with many people who were aware of the limited time they had to live, and many, if not most, related to me that after being given a "death sentence" they found more meaning in life than the had experienced in all the preceding years. 

There are only two absolutes about life when one is born.  They are going to experience pain, and they will die one day.

Doctors have to tell patients how it is. It's their job.

 

This is from a comedy show. 

 

 

I was a volunteer at a hospice in England for 10 years .. doing about 20 hours a week .... as my proper job gave me time off most days (I worked evenings).

 

As well as interacting with probably hundreds of terminal patients I had many conversations with nurses.  But never consultants .. ????

 

The policy was I was told for the Consultant to answer the patients questions truthfully .. never lie.

 

They had no right to lie.

 

So ... If they dont ask ... assume they dont want to know, and dont tell them.

 

Nurses would not answer obviously.  Not their job. 

 

Its probably off post .. but ... I must add being (for example) in a room with 20 or so day care terminally ill people was never all doom and gloom. There was usually so much laughter believe it or not from the patients.  But they had to get from the anger and painful "why me" stage to acceptance.  Difficult !

 

I stopped being a volunteer when I moved to working in varying parts of the UK but those 10 years taught me alot.  I could write (badly) a small book. 

 

I have had a desire once or twice to descibe one of many incidents that I found inspirational re the human spirit of many I witnessed but it never goes down well. ????????????????. In general people dont want to think about it.

 

When driving patients they often opened up more to the driver than to the doctor and nurses (about the emotions and problems they were having and had). This was because there was no eye contact ... the theory was. 

 

Most of us got a HUGE challenge ahead. 

Time to get things in order is a good thing, 

who gets what would be nice to do while you can, 

and given earlier if possible, if that's what you want to do, 

saves the arguments from those that are left behind in,

the queue.

Although you might not want to be told I think it's better to be told if you are terminally ill at least then you can go and put your house in order and try and enjoy the rest of your life what you have left of it, My wife was told on New Years day and Happy New Year to you!

56 minutes ago, Bluespunk said:

Netizens-the lowest common denominator, where intelligent thought is concerned. 

 

Everyone who contributes comment (and/or responds to it) on thaivisa.com is a netizen.

 

Do you really think all of them fit your description?

 

 

45 minutes ago, faraday said:

Rude cow, seems the Hippocratic oath doesn't exist here.

https://www.medicinenet.com/script/main/art.asp?articlekey=20909

'I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.'

An excerpt from the modern interpretation of the Hippocratic Oath.  It is not wrong to tell the truth and admit medical science has an inability to cure some problems.  To my mind it is more damaging to the patient and the family to give them false hope whereby they desperately seek alternative and more experimental treatments that would cause unnecessary mental and physical suffering to the patient; and mental and financial suffering for the family that has to finally face life without the patient.

Some people say they want to her the truth, and actually do. But they are rare, I think. Others really only want to hear the "truth" if it's good. Being told there is no hope can hasten them to their death.

 

My late father was chief physician in a postgraduate teaching hospital in the UK. He said he would never tell anyone they were going to die, much less tell them they how many months they had left.

 

His argument was that he had seen enough cases of people he thought were incurable yet who did, despite all the odds, recovered.  Everyone is different.

 

It is well established that mental attitude has a significant effect on chances of recovery, so telling people they have no hope is like kicking the psychological crutches out from under them.

 

He also believed that "bedside manner" was important, that a doctor who takes the time to explain the situation and encourage a patient is likely to have a higher recovery rate than the doctor who says, "Dead man walking. Next!"    

 

This is the response when you use social security. They simply don't have enough budget to treat with universal healthcare budget.

In my experience of Thai culture, it seems making other person "comfortable" rated far ahead of being truthful, so doctors really are up against it. I prefer to be told the truth in all matters, but I am a product of Western culture.

I'm just curious as to why anyone would want to film this. As for the main topic, I'd personally want to know the truth.

Truth is always better than BS to save some fluffy feelings. Rip the plaster off.

1 hour ago, jaltsc said:

Right!!! Denial is a much better course of treatment.

Certainly the usual approach here to most of what ails Thailand. Or feigning ignorance.

2 really good books on this topic.  How to Break Bad News by Buckman (used as text in many med schools)  also I Don't Know What to Say (also by Buckman.   The former is for medical professionals, the latter is for the rest of us.  You can find the basis of his six step protocol with a Google search. 

26 minutes ago, iforget said:

Some people say they want to her the truth, and actually do. But they are rare, I think. Others really only want to hear the "truth" if it's good. Being told there is no hope can hasten them to their death.

 

My late father was chief physician in a postgraduate teaching hospital in the UK. He said he would never tell anyone they were going to die, much less tell them they how many months they had left.

 

His argument was that he had seen enough cases of people he thought were incurable yet who did, despite all the odds, recovered.  Everyone is different.

 

It is well established that mental attitude has a significant effect on chances of recovery, so telling people they have no hope is like kicking the psychological crutches out from under them.

 

He also believed that "bedside manner" was important, that a doctor who takes the time to explain the situation and encourage a patient is likely to have a higher recovery rate than the doctor who says, "Dead man walking. Next!"    

 

I disagree with your father, a larger portion does die and it would be useful for them to know to have their affairs in order. I can see his side of it but the small group that does survive against all odds does not weigh up to the much larger group kept in the dark unable to make their final arrangements and spend their final time in a meaningful way. 

Providing a person with information in a clear unambiguous manner is to be preferred to offering platitudes and false hope.