msyamp
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65-year-old man comes to his physicians with complaints of abdominal pain that is persistent but not extreme. Workup reveals that he has metastatic cancer of the pancreas. The man has just retired from a busy professional career, and he and his wife are about to leave on a round-the-world cruise that they've been planning for over a year.
Should you tell him his diagnosis?
An 80-year-old Asian woman is hospitalized with weight loss, generalized weakness, and a pulmonary mass. Work-up reveals that she has pulmonary tuberculosis. Her family approaches the physician and asks that the patient not be told, stating that in her upbringing in mainland China tuberculosis was considered fatal and to tell her would be like giving her "a death sentence."
Should you respect the family's concerns?
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| mistral92
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1. for the fisrt case i think that you should tell him the truth i mean his diagnosis.
2. i think that you should respect family concerns.
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| drk1980
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first case, agreed. he might make make some important changes in his life after finding out the diagnosis.
second case, why not inform the woman abt her condition and convince her tht treatment and prognosis has definitely come a long way. Besides she needs to understand the disease well, in order to ensure compliance to the drug regimen.
or is 80 yrs of age considered too old to convince?!!
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| mistral92
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hello Drk1980, in the second case, and in my opinion you do not know the impact of getting that infomation on this patient ( risk of depression ect etc), don't giving the diagnosis does not mean that you are not going to treat her.
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| drk1980
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thanks mistral for explaining!
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| sturge_weber
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in the first case , u tell the patient has the right to know about the disease, and make decisions for himself
in the second case also u will tell the patient, but here u look for a choice hwere it says u approach the patient and ask what she thinks about the disease, and tell her advances, and then u go forward and tell the patient.
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| mistral92
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hello sturge Weber, for the second case i think that you are right i mean that you can make an approach, and try to evaluate her knoweldge of this patholgy...no problem...after that??? do you have to tell her the truth about her patholgy???? if you suspect that giving her the diagnosis may influence her negatively ( depression compliance etc etc...)??? i think that we have the obligation to tell to the patient their diagnosis BUT the exception is when you suspect that giving a diagnosis may influence negatively the prognosis...
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| gogetit
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YES.If the pt was with some serious condition that could harm his health with the disclosure of the news,only then the doctor can wait for the right time,but should disclose as soon as possible.but in this situation ,to avoid law suit by the romantic couple,u need to let them know immediately.
#2.The woman is an adult as as long as she is sane and competent,she is responsible for her health decisions.The family is sewcondary.The doctor should sit with the pt and try to find out the best way to let her know without harming her feelings.I think he should first try to find out pts comfirt level for the news.
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| msyamp
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second q answer
If a patient and their family members hold such beliefs, they should be respected, and a mechanism for informed decision making in collaboration with the family negotiated. One must not, however, assume that every patient of Asian ancestry holds the beliefs described here. The physician should make an attempt to explore the patient's belief system. If he finds that the patient does hold such beliefs about the harmful nature of truthful disclosure of the truth, then it would be justifiable to withhold the diagnosis of tuberculosis.
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| vamsi2004
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msyamp,, what is the answer for the first ques?
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