Different horizons

I am a great believer in telling patients the truth.

I do not mean ramming unpalatable facts down their throats whether or not they want to know but, nonetheless, I believe that doctors have a duty to make sure that patients understand what is going on.

I am fascinated by language and, in this context, by the verbal gymnastics that doctors and patents will use to skirt round the truth. I described here how a patient with incurable cancer can have a conversation with his doctor into which both read entirely different things.

Some (though fewer and fewer these days) doctors believe that, whilst you should truthfully answer any questions the patients ask, you should never answer questions that have not been asked.

I think this is a subterfuge. If my surveyor finds I have subsidence under the house, I do not want him to hide it in order not to upset me.

The patient may quite genuinely not realise how serous his illness is or, even if he does have some idea, he may not know exactly what to ask.

In telling the truth about serious illness and, in this context, we are usually talking about cancer, I am acutely aware of the fact that I have not (yet) had cancer myself. Who can know how someone really feels inside? I know what colour I see when I look at an orange but, whilst I suspect you see the same as me, I have no way of proving that.

I have a lot of experience, too much, of treating and supporting patients who do have cancer. If I know them well, and one of the joys of my area of medicine is that I do know most of them well, I can usually predict how they will react.

I believe that children, in particular, should be told the truth. Parents with sick children look horrified at this suggestion. But sick children, even more than sick adults, need to have confidence in those around them. If you lie, they will spot it, and they will spot it more quickly than you would believe possible. With children, however, I am much more led by their questions. I am prepared to be guided by them. I never, ever patronise them. If a child has leukaemia, I will tell him he has leukaemia. None of this “spot of bother with the blood, old chap” nonsense.

Children have different horizons to adults. Remember looking forward to Christmas when you were a small child? Ten weeks to go, and it seemed like ages. Now ten weeks goes in a flash and, as you age, it goes ever quicker.

I saw my patient whose son has myotonia congenita again. We have been talking about her stress problems. Part of her stress related to the fact that they have not told their son specifically what is wrong with him, and why he cannot do sports like everyone else at school. They tell him he has muscle stiffness. He knows that. He wants to know why. He is “only ten” said mum, we “cannot use expressions like myotonia congenita, he will not understand.”

I advised them to tell him, to use the words, and then answer any questions. Mum was worried it would frighten him. He still should be told.

She came back in today, all smiles. She had done it. She actually prepared a hand out for him. They sat down together and read it. He was initially fascinated. As he read through the symptoms, he kept saying, “That’s what happens to me; that’s what happens to me”.

Then, rather abruptly, he started looking agitated and unsettled. She was worried. She asked him if he was frightened. He looked mystified and said he was not. He said, “Look mum, this is very interesting but the Simpson’s have just started, can I go now…” and off he went.

Different horizons.

As he gets older, he will read it up more. He will seek the information when he is ready for it. And now, it will not come as a shock, and he will never say, and never feel, that his parents mislead him.