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Collusion in doctor-patient communication
- T R G Howard (20 May 2001)
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T R G Howard, GP Principle The Hadleigh Practice
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Editor - Three cheers for Kitty McCague of Washington (BMJ 28.4.01 letters). Partly because of her clinical circumstances and partly because of her freedom from the institutionalised thought processes of us doctors, she summarises concisely, unemotionally and with authority the concerns which many of us have about some aspects of oncology. O'Rourke et al state that 'false optimism as reported is not a problem that needs to be overcome'. Those of us, mostly in primary care, who have to absorb the distress caused by repeated expressions of false optimism, often in the face of overwhelming clinical evidence, would disagree strongly. If in the course of consenting a patient for an operation, a surgeon fails to tell a patient that it has only a 20% success rate, he might well be considered negligent. Many chemotherapy treatments confer benefit on an equally small proportion of their recipients, the remainder being arguably worse off. What gives any of us, be we surgeons or oncologists, the right to avoid giving facts with honesty? Many of us hoped that paternalism had disappeared years ago, but it is self evident that it is alive and well, disguised as keeping the patient's spirits up to the bitter end. Patients are not stupid, and have the right to make decisions, especially momentous ones, for themselves in the knowledge of all the facts. They and their relatives become understandably disillusioned and angry, however, when they are mis-led, however altruistic the motive. We would all do well to learn from Ms McCague. Dr T R G Howard
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