Should doctors be more blunt with patients?

In My Humble Opinion
1

I’m just curious what everyone thinks, and I’d be interested to hear the opinion of any medical pros too. I know of two people where lack of bluntness by doctors lead to shitty outcomes.

My niece died at age 18 from a stroke caused by complications from sickle cell anemia, she had almost non stop sickle events during her teen years.

Her parents thought when she was taken off the antibiotics when she turned 8? and the doctor was congratulating them on controlling it, they assumed this meant she is cured or at least no longer in danger. She saw numerous medical professionals in two countries up to her death and no one impressed on anyone the fact she had a terminal illness. Doing research later I thought it would have been a much better thing for a doctor to tell the patient or their parents this:

You have a terminal illness, assuming you don’t die in an accident or from something else it will eventually kill you. If you prevent and control sickle events well you can have an almost normal life span, if you don’t you will die much sooner.

I think that leaves no room for misinterpretation.
Second anecdote is my mother, which if you have read any of my threads you know what a whack job she is. But my sister attended doctor visits with her, so there is an independent view point. She has cancer and the doctor said they would perform surgery, but it was risky. He asked her to do a stress test first, and she declined saying she was too weak to run on a treadmill. The doctor then asked her to do some mall walking to build up her strength for it, and she declined saying she didn’t want to bother and it was too much effort. At this point he started making comments about how she had a long and fruitful life before telling them he was not going to perform surgery because she refused all his requirements and he did not think she was strong enough to survive it.

This shocked even my sister, my mom thought the comments about having a long and fruitful life meant he thought she was worth saving with surgery, and thought him asking her to do a stress test and mall walking was just general health recommendations like eat more veggies. My sister said even she did not understand that if my mom refused she would be denied surgery, as the doctor never bluntly put it that way that this was a requirement and not a suggestion.

I’ll admit my mom has always had problems picking up on subtle social cues and suggestions, which is why a blunt approach would have been better.

It seems that doctors trying to be coy and wanting to avoid scary words can lead to bad outcomes to me, and a blunter plain language approach would be better as they never know how much the patient knows about their condition or what their level of understanding of subtle language is.

Thoughts?

2

Sickle cell anemia is not a terminal illness: a terminall illness is one that will kill you no matter what. Sickle cell is like diabetes, in that, and I quote,

Did all those doctors in two countries have her whole medical history? Was one of them HER doctor? There may have been miscommuncation (although I know people who managed to ignore neon signs as big as the whole Vegas Strip put together, so it may not necessarily have been on the part of the doctors*), but there is also the issue of which doctor is the one who should have tried to burn the message onto a clue by four.

  • My mother still refused to accept that my father was dying 24h before he did. My brothers and Dad’s siblings were all surprised. This is three years after being misdiagnosed with “lung cancer (primary)” (turned out the primary was mesothelioma and the lung cancers were metastatic, so his two “clears” had been looking at the wrong organ) and after getting early retirement due to “incapacitating illness from which he is not expected to recover”.
3

I recall reading that those with sickle cell anemia even if well controlled do not have the same life expectancy as the average person, and that this is due to cumulative damage over a lifetime due to sickle events. That most with eventually die from the effects, but I may have misused the term terminal illness.

4

I have never met a doctor yet who seems to have any idea about the concept of honesty. I was told that my triple bypass surgery would be done without stopping my heart, but total BS. They had to extract it totally from my body they told me afterwards. Many other times I walked away shaking my head about the fact that the medic didn’t seem to understand the basic concept of honesty. I was prescribed pills for high blood pressure. After a few weeks I asked the doctor if this was why I could no longer get an erection. He flat out lied to me.I asked the pharmacist and she said , blood pressure is blood pressure, that it is what it takes to get an erection. SO I quittakingthe medicine and 2 years later I had the triple bypass above mentioned. I blame that on a lying doctor.

5

I think I’ve mentioned my champion example of M.D. bluntness here before.

In med school I accompanied an E.R. doc into an exam room to see a morbidly obese young woman who was there for a relatively trivial complaint. He examined her, described what the problem was and how it could be handled on a non-emergency basis. He then told her “You need to eat less” - and walked out of the room.

Yes, we need more direct interactions like that from our medical professionals and less sugar-coating. :dubious:

6

I’m not seeing the problem here. Your mother said she was too weak to walk on a treadmill or even walk at the mall, and the doctor concluded from this (and presumably the other information he had about her age and health) that she was too weak to survive the surgery. I’m not a doctor myself so I don’t know if this is a reasonable conclusion to draw, but he presumably wasn’t refusing to perform the surgery out of sheet spite. If your mother was too weak to do the stress test then she wouldn’t have been helped by the doctor pressuring her into trying anyway, as the end result still would have been him refusing to do the surgery on a patient he didn’t think would survive it.

7

There is something to be said for “bedside manner” though. Blunt can be good but in small doses. I hate the doctor who assumes I have high blood pressure because I’m nervous in the waiting room or being looked at as a drug seeker when I haven’t been to the doctor in ages yet seeking relief for a pinched nerve. I think it takes getting used to your doctor in order to have an honest discussion…something I have not done for fear of the unknown

8

My Dr. doesn’t sugar coat anything, he seems to go the opposite extreme and it has kind of a cry wolf effect on me. He tends to exagerate the certainess of bad outcomes if I don’t change certain lifestyle habits. I know he is right about what can happen but he makes it seem like it will happen tomorrow. If he said it might be tomorow it might be 20 years I might believe him more.

9

I think some lengthier medical counseling about the real risks of obesity and some more in depth info on how to loose weight would be more useful.

Just to be clear I don’t think my mom would have had a better outcome or was strong enough for surgery, but it would have been nice if the doctor was more open and honest with her about why he was asking her to do things.

Also rather odd but she asked how long she could expect to live, and he told he can’t give her any time frame because he doesn’t know.

With a single google search I found the five year survival rate for her type and stage of cancer on the American Cancer Societies website, which is 21%.

10

In previous times doctors in Germany were obliged to offer a glass of champagne to anyone they were telling their status was changed to dying.
So hearing a cork pop would not always thrill one.

11

Although I agree that doctors are often less straightforward than patients need them to be, I understand this one. There’s a huge difference between telling somebody what the average survival time is and telling her how long she can expect to live. When a patient asks that question, she is likely to take the doctor’s answer as a personal prediction, and that’s not something any doctor can do.

I know a number of people who are bitter because a doctor gave them a time frame for how long a loved one might survive and it turned out to be either much more or much less time than expected.

12

Sure I agree, but the obvious extension to the question is what is the average survival rate over time.

One doctor actually told her to go home and look stuff up on google when questioned about medical terms.:smack: My mom doesn’t even know what a web browser is.

13

In that case, I wouldn’t expect her to be able to ask, or understand, the meaning of “average survival rate”.

14

“… At this point he started making comments about how she had a long and fruitful life before telling them he was not going to perform surgery because she refused all his requirements and he did not think she was strong enough to survive it.”

I’m not sure any Dr need be more direct than this to an adult. If they aren’t hearing what he’s trying to say here, it’s got to be partly a choice. And I’m not sure it’s his job to ‘make’ someone understand.

15

I can see grude['s point. Maybe if the doctor had said she had to do the stress test to have the surgery, the mother would done it without giving any lip. Saving everyone embarrassment.

If he had wanted it to be a teachable moment, he could have made the request gently a couple of times and then, after the third “no”, said, “Your attitude is not a healthy one, Mrs. Grude’s Mother. I’m quite concerned this doesn’t forebode well for your wellness after surgery. If you won’t do a simple stress test for me now, why should I trust that you will do what’s needed for a speedy recovery? So I have to confess to having my doubts about whether you’re a good candidate for surgery.”

People can be sensitive, though. And in this social media environment, it’s nothing for a doctor’s reputation to be torn to shreds in a matter of seconds because he or she said something too bluntly. I once read a blog posting from an overweight woman who felt she’d been “fat-shamed” by her doctor, who’s only crime was telling her she needed to lose some weight. Yeah, maybe this particular patient didn’t need to hear this. But does this mean that no one else is in denial about their body size and wouldn’t benefit from that approach? No, it doesn’t.

16

Agree. And this is the point in the conversation where your mother or your sister could have backtracked and clarified that surgery would be an option if your mother did some work to build her strength up. But she didn’t, because it’s much easier to say the doctor refused to do it, rather than that she refused to make any effort to improve the odds of her surviving the surgery.

People often hear what they want to hear. My coworker’s mother was diagnosed with cancer. Because her mother had lost some weight and was not well enough for surgery, the decision was made to not go in and remove the mass. Coworker considered this a good thing. Yay! Mom doesn’t need surgery. Uh, no, not doesn’t need, just not an option any more.

17

When my brother in law was terminal, the doctors were not at all blunt enough. The weekend he died, we moved him out of ICU on Friday and my mother in law was making plans for a six month long hospice stay. She said to the oncologist “we will see you on Monday” and he said “I think he is likely to pass this weekend.” That was the first she heard that this was it.

I’ve since heard oncologists are often the worst for being blunt. I do have a friend who was told “investing in bananas is fine, I’m not sure if I’d buy next years datebook” in June - she passed in October.

18

When I worked in an auto shop, we were expressly forbidden to answer the question the inevitably everyone asked when we showed them something was wrong with their car: “How long can it go before it needs the repair?” “It needs the repair now,” was the only answer we could give, because the main office was concerned that if we estimated that the car could go a week before the wheel went flying off into opposing traffic, and someone made plans to bring it in in seven days, and on the sixth, they got into a terrible accident where lives were lost, because the car failed, we would be sued. They were probably right.

OT: it was scary to learn how many things were badly and sometimes deadly wrong with most of the cars on the road with me.

19

It seems to me there is no general rule for this. It depends on the circumstances and the personality of particular patients. Blunt is going to be best for some patients in some circumstances, whereas other times being too blunt is going to freak them out, or make them angry and resistant. Doctors have to try and judge which will be best in each particular case. Often they get it wrong. An ability to make such nuanced social judgements about people who are often virtual strangers is not really tested or taught in medical raining (I rather doubt whether it even could be practicably tested or taught), and with there being so many relevant variables and unknowns, even people who happen to have a natural aptitude for for making such judgements are probably quite often going to get it wrong.

20

I genuinely do not understand what you think was wrong with the way the doctor handled things.

But the mother said she wasn’t physically capable of doing the stress test, not that she just didn’t feel like doing it. If she couldn’t do it then she couldn’t do it, regardless of what the doctor told her. It wouldn’t save anyone embarrassment for her to collapse on the treadmill. It seems far worse to me for a sick old woman to feel pressured to undergo a test that would be too strenuous for her to handle if the end result is only going to be that the doctor declares her unfit for surgery anyway.