The doctor told me some news about my mother’s cancer; should I tell her? Wouldn’t it be better not to tell her and avoid upsetting her?

57. The doctor told me some news about my
mother’s cancer; should I tell her? Wouldn’t it be
better not to tell her and avoid upsetting her?

Mark’s comment:

If the doctor is telling you things that he isn’t telling his
patient, I feel that you should FIRE HIM. It is the doctor’s
responsibility to talk honestly with his patient, and if he
can’t do that, it’s time to find another doctor. This stuff they
used to do about “protecting” the patient was ridiculous
then, and it’s even more ridiculous now. Besides, if he’s
talking to you and not his patient, unless the patient is
mentally incompetent or a minor child, he’s committing
malpractice and you don’t want him laying a finger on
someone you love anyway!

Still, some doctors do avoid telling their patients bad news.
My friend Frank got frustrated by his first doctor, but
couldn’t figure out what the problem was. I helped him figure
out that the doctor wasn’t communicating well, so
Frank didn’t truly understand what was wrong. I would
ask simple questions about what the doctor had said, and
Frank wouldn’t be able to answer; he would complain that
the doctor was unclear, or say that they were scheduling
him for more tests before they’d tell him anything. The
doctor he was with at that time wasn’t a specialist and
didn’t seem to remember Frank’s symptoms or have a good
grasp of what was wrong with him whenever Frank had
an appointment. He even scheduled Frank for a test
requiring contrast when Frank had already told him that
he had an allergy to contrast! So when I put all of these
factors together and showed Frank the pattern, he realized
that he needed a different doctor—and he got the
“bad news” pretty quickly too, and found that it really
wasn’t all that bad.

For centuries, physicians often told family members
about a patient’s medical condition and did not tell the
patient, believing it to be too much stress for the patient
to handle. Until recently in the United States, patients
were specifically not told about a cancer diagnosis
because it was equated with an automatic “death sentence.”
This thinking has changed in recent decades for
many reasons.

First of all, cancer is becoming a treatable illness, and
there is a greater probability that people with cancer
will survive this disease rather than die of the cancer.
Second, because of all the treatment possibilities and
side effects of these treatments, patients themselves
need to be aware of what they will be going through so
that they can make good, informed decisions about
what treatments they choose to take. Third, ethically
and legally in the United States, patients need to be
told about their disease and about all reasonable treatments
in a process called informed consent. Informed
consent is based on the idea that individuals should
make decisions for themselves. It is a crucial process of
communication between physician and patient (and her
family, if she chooses), and often entails patients signing
forms indicating their understanding of and agreement
to certain procedures and treatments.

There are a few exceptions to adult patients providing
informed consent. Patients can be deemed incapacitated
for the purpose of making medical decisions, in
which case a surrogate decision maker or healthcare
proxy provides consent for procedures or treatments.

However, even if a patient is deemed incapacitated and
cannot provide informed consent, physicians usually
try to give a patient as much information as possible,
even if the proxy is the official decision maker. In other
circumstances, a patient may explicitly state to the
physician that he or she does not want to know anything
about the disease or treatments, designating a
person with whom the physician can communicate
and obtain informed consent. How this is handled
depends on the individual physician and hospital policies.

Or, in rare cases, a physician can determine that a
clinical exception should be made, indicating that
telling the patient about a medical issue would cause
so much psychological and emotional harm to a
patient that it could affect the medical condition or
safety of the patient. For example, a physician may
postpone talking about the cancer with a patient with
severe depression or with one who is actively suicidal
until he or she is psychiatrically stable.

Cultural circumstances may impact whether family
members want a patient to be told “bad news,” such as
the initial cancer diagnosis or the spread of the cancer.

In some cultures, it is common for adult children to
completely manage their parents’ medical care, including
speaking with the physicians, deciding about treatment,
and so forth. However, in the United States,
these cultural standards are sometimes in conflict with
the legal standards and ethics in medicine. Communication
with the doctor, patient, and family can often
clarify such concerns.

Physicians may tell the family more about a patient’s
illness than they tell the patient. Initially, you may
think this is a good idea. However, we have found
that it can be difficult for the more informed family
members for many reasons, not the least being that
they know a “secret” that the patient does not know
about her own body. Secrets are often disruptive to
communication, since family members have to hold
back their emotional reactions to the news to “protect”
the patient. This can create distrust between
the patient and the family (since patients almost
always realize when things are not being told to
them) or between the patient and her physician if
the patient does not believe the doctor is being
truthful with her.

In summary, unless there is a really good reason not to
tell your mother, she should be told about the news, no
matter what it is, ideally directly from the physician herself.

Try not to take on the “go-between” role of relating
information from the physician to your mother, since
this can be a very stressful role for you to assume. If the
physician tells you things in the future, you may want to
direct her to your mother and have the discussion
together. Patients usually find out the truth anyway, and
it is the not knowing that increases their sense of being
out of control.We have found that patients usually handle
things better than their family and doctors expected,
and that information is a crucial part of patients establishing
a sense of control. Not knowing, as our patients
often say, is worse than knowing the worst.


Informed consent = After a patient is educated about his 
or her diagnosis and all reasonable procedures and 
treatments  options for the disease, he or she must
indicate an understanding of and agreement to a
course of action by signing forms.


Incapacitated = A term used when patient is deemed by
the medical team as being unable to give informed consent 
for a medical procedure (i.e., comatose, mentally disoriented).


Healthcare proxy = A document (also called medical
durable power of attorney or healthcare agent) designating a
family member, guardian, or friend as the decision maker
about medical treatment for a patient.


Surrogate decision maker = A person designated to make 
healthrelated decisions for that patient. The medical
team addresses all healthcare issues for the patient directly 
to the surrogate.