Intended for healthcare professionals


Talking to patients about cancer

BMJ 1996; 313 doi: (Published 21 September 1996) Cite this as: BMJ 1996;313:699
  1. Robert Buckman, Medical oncologist
  1. Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada M4N 3M5

    No excuse now for not doing it

    An extraordinary thing about the medical profession is that it managed to avoid telling the truth to patients for so many centuries. In 1672 the French physician Samuel de Sorbiere considered the idea but thought that it might seriously jeopardise medical practice and concluded that it would not catch on.1 This approach—recognising the need to act but finding excuses not to—is still in evidence today, even though there has been a considerable change over the past 35 years. Two papers in this week's journal remind us that what is comfortable for clinicians is not necessarily what patients want.

    In 1961, a landmark paper by Oken showed that 90% of surgeons in the United States would not routinely discuss a diagnosis of cancer with their patients.2 However, several studies subsequently showed that a growing proportion of cancer patients wanted to know their diagnosis. The proportion of patients wanting to know has varied in different studies, depending on the locale and the sample (Northouse has done an excellent overview3, but has often been in excess of 90%.

    Medical practice has gradually changed to meet patients' needs, particularly in the United States, and nearly 20 years after the Oken study, …

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