Consults:
However difficult it may be for you, I think your patients and their families expect you to tell the truth. Doctors hold a place of trust in our society. Won't a lie poison that trust and relationships with other doctors?
I"m with Jeff. And as a parent who was IN that situation, I carry a huge amount of respect for the doctors who took a deep breath and told us our son would likely never recover. BUT, they also waited until we were ready to hear it and they knew when that was because they kept open communication with us.
Families just want to know that you CARE about their loved one.
I enjoy your blog a lot.
Wow, "an empty bowl of nothing" is just about as perfect a description as I've heard to describe it. That's what it feels like you're being given too. Personally, I'd rather have the benefit of your opinion, whether it's favorable or not. Give me SOMETHING, please, not a bowl of nothing.
I so appreciate your blog and your transparency. You have a very difficult job, I know.
Living with it right now.
An anesthesiologist got PO'd by my decision to forego sedation and let me know it. Talking with the surgeon afterward was a joke. No honesty - just vague suppositions.
I appreciated so much more, the nurse's blunt concern for me and her willingness to be realistic with what she shared.
We appreciate it - we really do.
"We tiptoe around the hospital offering neither hope or despair, just an empty bowl of nothing, served with a fake smile. And a side of Percocet."
Nail. On the head.
Dang, girl.
The doctors I respect are those who are willing to share their honest opinion with me rather than play the "politically-correct-I-can't-tell-you-what-I-
really-think" game.
When I ask a question, I want an honest answer. I know doctors aren't God and I know they may make mistakes. I take what they say as an opinion only... and when they refuse to tell me what they think, it infuriates me. How can I trust someone who won't honestly say what they really think?
I'm glad you don't want to be numb and that you recognize the lies that are said in the medical profession. Please keep being honest because we need doctors like you more than you know.
As medical professionals we are expected to have all the answers every time. We certainly have the education, training and sometimes the experience to render an opinion. But sometimes, I've learned, the correct answer is I don't know. It's okay to say to a patient: "I understand how difficult this is going to be for you, but I can't answer that. I don't have control over it. I simply don't know." I think they usually appreciate that kind of openness and honesty, even if it's harder to accept.
Every time I open my mouth to a patient I pray that God puts the right words into my mouth to help me reach them the way they'll accept it.
LOVE your blog. Thanks for sharing!
You are a smart woman & I have no doubt that when the family needs to hear more...you will tell them. Sometimes you do have to wait these things out a bit. You know as well as I do that miracles do happen in healthcare. I think Josh hit the nail on the head.
All anyone can do is your best, be honest with the patients & family when they ask & sometimes before they ask. Most importantly, ask God to guide you in all things....it works.
How I wish you were on our staff at our hospital! We have great doctors here but we could always use another one with a heart & mind like yours!
I loved this post. We do often tiptoe around the truth or avoid it altogether when dealing with sick patients. It is a little easier for me since most of my sickest patients are old, and it is often "their time" and so the family is ready to hear what really is going one. But tragedies still happen and I often find myself sugar coating reality because deep down, I too hope for a miracle.
hit a soft place in me this morning....thanks
OH, for more Dr's like you.
It's hard when dealing with these types of situations, but in my humble opinion, I think it is best to be honest with the parents so they know what to expect. So when the time comes they wont say but the doctors said she was doing ok.
Parents are parents, and even if you are honest with them and they try to understand, they will always have hope that the doctors are wrong and that their little girl or boy will come back to them.
It seems like a lot of us are on the same page. You know, the one thing I "resented" when we left Seth was that I felt the drs. hadn't been serious enough with us about his condition. Seth had HLHS and while we were told "this is VERY serious", it also felt like the prevailing attitude was "but he'll have these 3 surgeries and be just fine". I get that a parent can't live with "we could lose him at ANY moment" if that's not necessary but sometimes I feel like they didn't emphasize how serious things were..
At the end, though, like I said above, they were gentle and honest and caring. We couldn't have aske for more.
I find it refreshing that you want to be bold!
My fiance is a PGY2 in internal medicine. Every post you write is true to the experience of the emotional/physical/intellectual challenges that residents face. And I understand why honesty isn't always the best (or easiest) policy in these situations.
When you are no longer under someone else's tutelage - what will you choose to do? Having dealt with too many situation where I had to make a decision based on information from doctors - I have prayed a lot about forgiveness - false hope is a lie - no coloring it up as "kinder" - that just means easier for the medicos to do not for people to hear. There are things which must be done by family and loved ones and if we don't know the truth - the real one not the relative/psychobabble one - we don't get an opportunity to prepare. Death isn't the end - at least not for believers - but we all like to have some preparation for saying our earthly farewells. Whew - hot button here - sorry - your description is beautifully written and the situation is tragic. Doncha wish for a rewind button some days? one of those Groundhog Day things so we can do it 'til we get it right? Thank you for being so open - and let the music heal what words cannot.
I would prefer the cold blunt truth. I think most who don't receive it suspect it anyway. Not everyone is the same. My MIL was Dx in January w/ metastatic bone cancer after breast ca 9 years ago. She has said flat out, "I don't want to hear any bad news" ... believing if she hears bad predictions, they will become true. Everyone is different.
I work at a children's hospital as a parent who consults with hospital staff on topics like this one. It's fascinating to me to hear how different people are.
I personally want to hear the pros and cons of every option, in gory detail. I appreciated a surgeon's estimation that our daughter had a 20% chance of surviving her first surgery, too. It is crucial to me to have realistic expectations -- I HATE surprises, especially medical ones, which are almost always bad.
But like Lisa said, some people refuse to hear or speak anything bad. They are almost superstitious -- if you don't say it and don't hear it from anyone else, it has no power over you. They won't entertain the possibility that something could go wrong or has gone wrong.
The trick for doctors is to find out what kind of person this is. I'm sure that isn't easy, given the time constraints, patient volume, and fatigue.
I really appreciate your blog and the window into the world of doctors.
I've followed your blog for some time now. As 4th year medical student going into pediatrics, I have enjoyed reading your insights and experiences in the field.
As I read this post, I was moved to the brink of tears. It was as if I was meant to read this post today. So much of what you've written conveys many of the exact thoughts that I've been struggling with for the past few days. You have truly been blessed with the gift of words. Thank you for sharing your gift with the rest of us.
Having been on the receiving end of the Dr. allowing us "to hold onto hope." We would rather be told the truth & begin to prepare for what is going to happen. In the back of their minds, they know the truth & when it doesn't get better, some family memebers will hold you responsible. I wouold trust a Dr. more that told me the truth.
I have been at the bedside of a loved one and fed "empty bowls of nothing" from a doctor whom I asked to tell me the truth, what to realistically expect. I trusted this doctor to tell me the truth.
It is a great disservice to the patient and their families to not be up front with reality. ESPECIALLY if the families ask.
In my situation, the precious gift of time in preparing and saying my good byes would have been priceless. I was robbed of that.
Whether the doctor was trying to spare me or was simply too uncomfortable or unwilling to take the time to answer the inevitable questions the truth would have lead to, I'll never know.
Please don't think I'm beating up on you, about your situation. I'm not. Just relaying my experience, for what it's worth.
Thank you, for the time and heart you put into your blog.
Although our circumstances are different, I get asked all of the time about the condition of a loved one.
Often, it is when my crew is performing CPR on a patient as they are driving off in an ambulance. I cannot lie. I tell them that the situation is dire and that their loved one is in a very bad way.
I do so with compassion as I have felt their pain. I also tell them not to lose hope as, people have recovered (although rarely) from the same situation.
Both statements are true, I can live with myself as a result.
Great post, thanks.
As a patient, you quickly sense even in a crisis situation who is being honest and who is feeding you the lines they think you want to hear. I trust the doctors who are honest and am forever skeptical of those who dodge the truth. How can I trust someone with my life, or the life of a loved one, if they can not even look me in the eye and tell it like it is? Hope is not destroyed by the truth, but illusions and misconceptions are swept away. Hope is not clinging to some false pretense, some sugar-coated reality. It is knowing the truth and choosing to believe in something, someone anyway. Hope knows that things may be impossible, but is the forces that allows one to continue onward and make it through. Lies, omissions, dodging the truth do not sustain hope but rather they taint it. Patients and families deserve the opportunity to know the truth, to live and love with full disclosure, and to choose hope in spite of everything.
Danielle, would you allow me to quote you? I'm putting together a presentation for the residents at our hospital on this exact topic and would LOVE to share what you wrote. I would also like to share some of the comments above -- they are so powerful. If you have a second, would you drop me a line at the email I've registered for this comment? Thanks!
First of all beautifully written. Secondly, I think it depends. When it comes to predicting outcomes of a brain damaged child - stay neutral because no one really knows - they just don't. But I don't think all situations are like this like the person who got balled out by the anesthesiologist about getting pain meds. It just depends and that is uncertain ground for all of us.
I'm grateful you're not one of them. It's so obvious you're not, and with a deep sigh of relief, I'm grateful for that.
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