Only the truth: 10 rules for communicating with a seriously ill person

1. Tell the truth and nothing but the truth

Lying to a patient is not only humiliating, but completely useless. The patient needs 15-20 minutes and mobile Internet to convict the doctor of an elementary lie. It is somewhat easier to deceive an elderly person, but also difficult: these people have their own community where they exchange information and get to the bottom of the truth.

Realizing the deception, the patient can extrapolate the situation to all doctors without exception and completely stop trusting them — in some cases this subsequently costs him his life.

2. Give complete information

About the diagnosis, upcoming surgery, outcome and prognosis of the disease, risks and complications. This is not only legally necessary, but also elementary simple. The patient must understand what is happening to him, what is planned to be done and why, what to expect from it.

You need to speak in cold blood, without pathos and wringing of hands, in an accessible language, if possible — with humor. Tragic intonations should be avoided with cancer patients. Compassion is not a tear in the voice, but understandable actions.

When a patient sees that the surgical team, for example, is aware of the risks of surgery and knows how to deal with these risks, he sleeps much more peacefully.

3. Never hide from difficult conversations

This is a very difficult task, because the doctor gradually burns out himself from difficult dialogues. Nevertheless, the patient cannot be “fed with breakfast” about the fact that permanently paralyzed hands move in or an ultra-malignant, totally unremovable tumor is actually a cyst (as some people like to say, a “polyp”).

To take away a person’s right to objective knowledge of one’s own problem is absolute bestiality; this is his body, his fate, his life and death, and we are admitted to this knowledge only by virtue of the profession we have received (that is, we get money for this, and then we buy food and gasoline with them).

4. Avoid Stop Words on Your First Conversation

Such words include, for example, the word «cancer». Personally, at the first communication, I avoid this term, I replace it with synonyms — it seems to me that the patient can immediately be so shocked that he will stop cooperating for a long time, he will become isolated in captivity of a terrible word.

This is a purely human thing, connected with speech turns: after all, the diagnosis of «diabetes» is sometimes worse than the diagnosis of «cancer», but no one jumps out the window from diabetes. When a person recovers from the first shock, you can call a spade a spade.

5. Directly answer direct questions

If a person openly asks «When will I die?» or “Will it hurt me?”, one should just as openly tell the truth. The patient may have a lot of unresolved life issues, including a loan, a mistress wife, idiot children, and he must understand the scope of work.

When answering such questions, one should operate with clinically evidence-based information, expressed as percentages, five-year survival periods, and quality of life scales. Thus, in order not to accidentally lie, one must constantly read scientific articles and have updated information.

6. Never blame

Some patients before coming to us behave so destructively that they really want to be beaten, or it is reasonable to ask: “And you, my dear, what do you want from me now?” Nevertheless, blaming a person for his own stupidity or failure is inhumane and non-constructive: now what’s the point when he has already come to you?

Yes, he is stupid, he grew a huge tumor, spent all his money on a shaman and a fortune-teller, his former doctor is a fool, and his wife is a market woman. Well, nothing, then it is necessary to treat the one who was sent.

7. Prescribe antidepressants

And if necessary, immediately invite a psychiatrist. Seriously ill people almost without exception have depression. And in what, in fact, should a suffering person be in a state — to jump like Gummi bears?

8. Find out with whom you can discuss his diagnosis

If the patient is an adult, conscious and sane, it is necessary to find out whether it is possible to discuss the diagnosis with relatives, and if possible, with whom exactly (for some reason, this item is almost always ignored).

A serious illness is a problem of several people, sometimes several dozen people. They must understand the reality, prepare for time, organizational and financial costs.

It is necessary to understand which of the relatives is the “treatment organizer” — sometimes it is not a son / husband / mother at all, but some kind of great-uncle, first wife or distant friend. At the same time, it is necessary to understand with whom the diagnosis cannot be discussed, referring to the legal concept of medical secrecy.

Careless words can lead to suicide of a relative or the patient himself (such cases are widely known). Telling the truth to the wrong person is burdensome for karma: your patient may have died a long time ago, and family members will curse you to the seventh knee.

After the operation, the patient should put his mobile phone in his hand and give the opportunity to call relatives. I don’t know how it works, but sometimes it works just as well as intensive care.

9. Explain everything

Explain the main organizational arrangements: for example, if the disease is accompanied by chronic pain, the patient must understand that it is necessary to register with an oncologist at the place of residence in order to receive narcotic painkillers.

The patient, faced with a cruel and inhuman system of providing (non-provisioning) care at the post-hospital stage, is completely defenseless and confused: he needs to be instilled with at least basic ideas about what to do.

10. Do not ban smoking

And in the end, one more personal observation (for the judgment of colleagues): do not prohibit heavy smokers from smoking immediately after oncological operations.