Education And Debate Ethical debate

Truth, the first casualtyDeadly charadesCommunication is a vital part of careDoctors and patients should be fellow travellers

BMJ 1998; 316 doi: (Published 20 June 1998) Cite this as: BMJ 1998;316:1890

Truth, the first casualty

In the past, patients with cancer were often not told the truth about their condition. This would be considered unacceptable nowadays. Yet Mitzi Blennerhassett's account of her treatment for anal cancer shows that truth can still be one of the firstcasualties of a system of medical education and training that may dehumanise patients … and doctors. Here a cancer specialistand a former professor of general practice comment on Ms Blennerhassett's experience.

Deadly charades

  1. Mitzi Blennerhassett, counsellor
  1. Wyville Lodge, Sligsby, York YO62 4AQ
  2. Department of Cancer Medicine, University of Sydney, New South Wales 2006, Australia
  3. Westgate Barn, Milburn, Cumbria CA10 1TW

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    Being fed “tailored” truth and outright lies was psychological torment I felt continually humiliated, manipulated, out of control. The need for truth became an obsession. The necessity to prove competence in order to obtain information became a barrier to communication. They withheld my rights: I confiscated theirs. With integrity eroded, status erased, I felt as though I was living through One Flew Over the Cuckoo's Nest.1 Smiles deceived, reassurances deluded, suspicions were not shared. But misplaced kindness became brutality as the bad news broke. And the deceit hurt.

    The diagnosis was squamous carcinoma of the anal canal.“Basaloid” was written in my notes. Passing from surgeon to oncologist, treatment options reduced from three to two and my“hernia” changed category. I was not informed they were about to take a biopsy specimen. Silence intensified as they prepared a needle for the lump in my groin. Suspicions confirmed, I gave my“informed” consent over the phone.

    Side effects, I was told, were“nausea, tiredness, diarrhoea and wind.” Nobody mentioned pain. Nobody said this was pioneering treatment (fluorouracil, mitomycin, and radiotherapy (85 Gy)).2Nobody mentioned risks or long term effects yet only I could have assessed the full implications of these. Recently, with great persistence (impossible when debilitated), I learned that high dose radiotherapy causes progressive damage in anal cancer, giving a 70-75% probability of late failure. (The remaining 25% of patients presumably …

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