How Would You Like to be Told that You Have Cancer?

I would like to start a followup conversation on a thread that I began September 25, 2005 titled "Telling 'Bad News': But There is More to Tell" The question is how can a doctor tell a patient that he or she has cancer without the patient "freaking out" at that moment and not being able to be educated by the doctor about the nature of the cancer, the various approaches to treatment and the outcomes. What suggestions would you give regarding how the doctor can meet the emotional needs of such a patient as well as to provide necessary education that will be needed for future decision-making? How would you like to be told that you have cancer? If this has happened to you in the past, it would be worthy for me and other physicians to listen to your story about how you were told and how you dealt with the information and education... and, of course, your suggestions. ..Maurice.

Graphic: Painting John the Baptist by Guido Reni (1575-1642)

Patient Modesty: Volume 44

It has become clear from reading all the responses to this thread "Patient Modesty" that the issue of physical modesty in the context of medical care is not gender specific. Patients of both genders need attention by the healthcare providers to their modesty concerns. And yet, it appears in many situations, this attention is not being applied to that patient and because of resource differences, particularly with regard to the male patient. In addition, perhaps unrecognized to many of us, and as brought to our attention by the "stressed student" (SS) in the previous 2 Volumes even medical students may be aware or personally concerned about how and what they are being taught regarding sensitive genital and rectal examinations. Now.. continuing on with the discussion we will begin Volume 44. ..Maurice.

Graphic: Photograph of bronze Auguste Rodin's "Burghers of Calais-Pierre de Wissant" taken by your moderator 8-13-2011 at the Norton Simon Museum, Pasadena, CA

NOTICE: AS OF TODAY NOVEMBER 8, 2011 "PATIENT MODESTY: VOLUME 44" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 45

The Price of Precaution and the Ethics of Risk

I am borrowing the title of a book by Christian Munthe published by Springer for this thread. I will not be using the title, perhaps, in the same general context as Munthe but using the words as I imagine their meaning when applied to medical care.

One will find many examples of precaution and their corresponding examples of risk in how medical care is provided by physicians and accepted by patients. In fact, not only do these two elements correspond but at times the price, itself, of precaution becomes the risk. Risk is everywhere in medical practice. Risk is present when a patient is selecting a physician. The risk is becoming the patient of a doctor whose professional behavior does not meet the goals of a "good doctor" set by the patient. It is often that the patient really has no chance to predict how the doctor-patient relationship will turn out since the patient is often immersed in the relationship already by the time the uncertainty about that doctor begins to develop. Ideally, the patient should be cautious of all physicians from the onset as to how that relationship will turn out unless the patient doesn't care. Recommendations by neighbors, family or even other physicians may be helpful but are only the views of others regarding what is strictly a personal relationship. Precaution in the making of a selection of a physician is not often fully available due to time and medical urgency and inadequate communication between patient and doctor. The price of precaution in this example can be what turns out to be unnecessary and harmful delay in diagnosis and treatment in the attempt to find a satisfactory medical provider. On the other hand, not accepting a physician for personal consultation without an introductory "get to know you" appointment, if accepted by the physician, would be of great benefit for the patient's comfort with subsequent medical consultations.

On another thread on this blog, it appears that patient physical modesty issues become a risk. The visitors write about the emotional risk of examinations and procedures in terms of their emotions associated with that modesty. It is related to the presence of those attending or looking on being of the opposite gender than the patient. The inability to obtain an environment free of those of opposite gender including the physician, nurses and technicians may lead to a decision by the patient to avoid the exams or procedures even if their life was at stake. Such is the price of their caution.

Yet, even absent the context of physical modesty, precaution may be elicited in a patient's decision whether or not to accept a necessary medical or surgical procedure in face of the risks of that procedure. Presumably, that decision is based on information regarding the statistical value of the procedure vs the side-effects and life risks of the procedure. A patient's precaution decision against the procedure may have a price of further sickness or death.

Risk may often be warranted and thus beneficent to the patient. It may turn out, in medical practice that the price of precaution is not worth the benefit permitting a risk. The physician the patient received before searching for others may be the one who could diagnose promptly and correctly and cure the patient. It could be that the risk of emotional upset related to the physical modesty issue, concerning opposite gender presence is not worth the outcome of avoiding the examination or procedure. And finally, the price of precaution leading to the rejection of a procedure based on statistics instead of "taking a chance" on being the statistical outlier who would benefit despite the risk would be to the detriment or even the death of the patient.

What is your philosophy regarding balancing precaution and the apparent risk in medicine? ..Maurice.

Graphic: "Better Safe than Sorry" text image created by your moderator 8-20-2011.

Extra-Marital Sex: Spouse of the Demented Marital Partner

Without additional discussion by me, I would like to pose a question to my visitors. There is a husband or wife of a severely demented (institutionalized Alzheimer's) patient who asks the doctor whether it would be the ethically right thing to do to engage now in extra-marital sex. What should be the doctor's response? Or what should the doctor find out before responding? ..Maurice.