Viewpoint: When telling the truth harms patients

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Being truthful with patients about their prognoses is one of a physician's most difficult responsibilities. But when critically ill patients are in denial during their last hours, it only adds more pain, a pulmonary and critical-care physician wrote Oct. 6 in an opinion piece for The New York Times.

Daniela Lamas, MD, a physician at Boston-based Brigham and Women's Hospital, wrote about her experience with a colon cancer patient whose disease was beyond treatment. 

After his colon cancer diagnosis, the patient "disappeared from medical care" and didn't respond to follow-ups to schedule appointments and start chemotherapy. When he arrived in Dr. Lamas' intensive care unit nearly a year later, his disease was beyond treatment and there was nothing more the team could do apart from providing comfort during his final hours. 

The patient displayed "impenetrable denial," insisting nothing was wrong with him and that he wanted to go home, Dr. Lamas wrote. 

She recalled her response to the patient: 

"I wish there were something we could do, but the cancer is too advanced. You're dying. It could be hours now. I don't think you will make it through the night." 

Part of this response was an attempt to cut through the patient's denial, and part of it was her own frustration "at the avoidable nature of this tragedy, at how denial had turned deadly," Dr. Lamas wrote. 

"This man was scared and he was going to die of a disease that might have been cured. And I could do nothing about it. When I told him that he had only a few hours to live, I allowed my frustration to obscure the reality of his suffering." 

The patient died later that night, and over the next few days, Dr. Lamas couldn't shake that moment at the patient's bedside from her memory. 

"What had I hoped to accomplish? As a doctor and purveyor of science, it can be difficult to accept that sometimes the 'truth' is not what a patient needs. Denial was my patient's only defense mechanism. And as soon as the words left my mouth, I realized how cruel it was to try to take this defense from him in the final hours of his life," the physician wrote. 

In most situations, it is in fact a physician's duty to tell patients the truth, but in this case it only added to a patient's pain in his final hours, Dr. Lamas wrote. 

"I wish that I had done it differently. I could have paused and told him that yes, he was going to go home. I could have simply been there with him and said nothing at all. That small kindness might have done more for him than the truth."

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