If there’s one thing sacred in the doctor-patient relationship, it’s trust. Open and honest dialogue on both sides of the exam table is critical to effective care. Patients have to be truthful to ensure diagnostic accuracy and an appropriate treatment plan, while doctors need to provide full disclosure about their patient’s health — the good and the bad — to help patients make informed decisions. That patients are entitled to the truth, then, is a given, but just how much doctors are obligated to reveal is in fact a matter of much debate — particularly as it relates to the sick and dying. The never-ending question is: How do doctors balance their obligation to be truthful with their desire to be compassionate? Informed consent wasn’t always the mantra. As little as 30 years ago, cancer patients in the U.S. were frequently misled about the extent of their illness. Go back 100 years and you would find doctors withholding from patients the seriousness of their conditions, even including those who were terminal. Today, physicians in most states are legally obligated to disclose all relevant health information to patients. What about compassion? While outright lying to patients is rare, many physicians — particularly oncologists — say that at some point in their career they have failed to answer questions directly, given incomplete information about the burden or benefit of treatment, and otherwise avoided "imminent death" discussions with patients suffering from an advanced disease. Most patients want to know what they have, what their options are, and what's going to happen to them. Above all else, they want assurance that their doctor won’t abandon them when their treatment options run dry. Disclosure enables patients to plan — to create a will and living will, make their wishes known to family members, pass along what they've learned to loved ones, name a durable power of medical attorney, decide where they want to spend the rest of their life, and make spiritual and family member amends. Treating patients is a complex business, and sometimes doctors have to have tough conversations with their patients.
