On my first placement I was confronted with a situation in which I was made uncomfortable by the wishes of a patients family. The other PT student and myself had been treating this elderly gentleman who had come in for a craniotomy and excision of a tumour. We had been treating this patient for a week before further investigations revealed metastases in his lungs. His prognosis was declared poor and our rehabilitation aims changed as a result of this.
The medical findings were explained to us in the morning and a previously scheduled family meeting was to take place that afternoon. At this meeting his family, which consisted of a wife and a few daughters, requested that the patient not be told of the new developments. It should be noted at this point that although the patient did experience occasional periods of drowsiness, he had no other significant cognitive impairments.
This was explained to us before we went and saw him again and was obviously the cause of my discomfort. The patients family are the closest people to him and as hard as we try to treat him and help him get better we did not have the same degree of responsibility and emotional attachment that the family would. On the other hand what if the patient asked me about his condition and the results of his tests? Am I supposed to mislead the patient about a condition that affects him much more than it does me or even his family?
This was made even more difficult when during one session a doctor came in and informed the patient that he was "Dr. X from Oncology" and that he would need to speak to him later. Thankfully the patient didn't ask me anything about it, as patients are quite prone to do. During the course of the day my choice of action crystallised and I knew what I would do.
After discussing this with the senior physiotherapist and medical staff, it was decided that although we would not divulge any information for the time being, if the patient asked us a question we would answer it truthfully. Even if this led to the patient finding out about the progression of his cancer.
If this situation arose again I would do exactly the same thing, I would respect the family's decision to inform the patient at an appropriate time but if the patient was fully cognisant I would always answer truthfully any questions they had about their illness.
2 comments:
hey, totally understand your dilemma. I would be like you feeling that I have the moral obligation to be truthful to the patient but when looking at it from the family's point of view, it'll not be as simple as it seems. I say that because I was in a similiar situation last year when my grandmother was admitted to hospital and due to weakness in her legs and it was found that she had a tumour in her brain which was the most maglignant of all brain tumours and the doctors gave her a prognosis of 6 months max to live.
The family struggled to decide what to do and it was over lots of tears and arguments that we decided not t divulge anything to my grandmother and requested the medical staff to do so too. As a health professional i share your view point, but when you are the family involved, it changes everything.
It's great to have a comment from someone who has gone through it.
Cheers Mel
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