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The authors have explored the issues here wondefurlly, and describe
scenarios which sound very familiar in my experience as a doctor, friend
and relative.
It seems to me that the point of the communications described here
must be to allow sensible, informed choices about much more than treatment
options. The authors illustrate the adverse consequences of collusion:
especially not planning for death. They also make one suggestion of a
"solution" to the problem of false optimism. I think that their solution
sounds over complicated. I have another suggestion, drawn from a problem
solving approach.
It may not matter whether a poor prognosis is discussed openly or
with blunt honesty. The consequences of the prognosis, however, must be
shared and understaood so that families and individuals can do the
practical things they need to. A most elegant illustration of this came
to me as a junior doctor. When I asked if the person I had just clerked
in had anything he wanted to ask, he replied "I was thinking of writing my
will when I go home...what would you advise?" The advice was not to wait
till he went home..
Doctors and others who advise patients on diagnosis, prognosis and
treatment options have a duty to communicate clearly and understandably.
This may include advising a person to write their will, make sure they
spend time with their friends and relatives, not wait for their holiday
till next year. Who needs to talk about prognosis if the practical advice
is given?
Breaking the cycle of collusion or encouraging a practical approach to life?
The authors have explored the issues here wondefurlly, and describe
scenarios which sound very familiar in my experience as a doctor, friend
and relative.
It seems to me that the point of the communications described here
must be to allow sensible, informed choices about much more than treatment
options. The authors illustrate the adverse consequences of collusion:
especially not planning for death. They also make one suggestion of a
"solution" to the problem of false optimism. I think that their solution
sounds over complicated. I have another suggestion, drawn from a problem
solving approach.
It may not matter whether a poor prognosis is discussed openly or
with blunt honesty. The consequences of the prognosis, however, must be
shared and understaood so that families and individuals can do the
practical things they need to. A most elegant illustration of this came
to me as a junior doctor. When I asked if the person I had just clerked
in had anything he wanted to ask, he replied "I was thinking of writing my
will when I go home...what would you advise?" The advice was not to wait
till he went home..
Doctors and others who advise patients on diagnosis, prognosis and
treatment options have a duty to communicate clearly and understandably.
This may include advising a person to write their will, make sure they
spend time with their friends and relatives, not wait for their holiday
till next year. Who needs to talk about prognosis if the practical advice
is given?
Competing interests: No competing interests