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 any-thing 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 her-self. 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.