Sunday, July 21, 2013

Hope in Medicine.

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I'd often wondered why after being told about being told that I had a deadly disease, everyone seemed to be trying to lift my spirits. Everyone but my doctor. 

In the end, he didn't give me a direct message of hope, ever. Not once did he say something like "Don't worry, you may have a 10 - 20% chance of surviving, but that doesn't mean you're a goner," or "I know it seems hard now, but if you go through this, you may just survive and come out a better person," or "It's okay kid, those other doctors suck compared to me."

And I can see why. As a doctor, you can't sugarcoat bad news to a patient. You just can't. You've got to be honest to them, no matter how bad it may seem. You can't go into every room and cry out "Don't worry mate, you'll be fine. Just give it a few weeks." 

Giving people false hope will, in the overwhelming majority of cases, be more harmful than telling them the honest truth. No matter how bad the news may be. To be given that hope and then have it taken away when you are told that you're terminal, or when you realise that your life is now filled with medications and restrictions when someone told you it'd all be the same is deceitful, and just cruel. 

And the worst thing is, if you do that as a physician, that patient, or his family and friends will never forgive you. And that's not easy to take. In fact, it's devastating. 

Doctors are, in the end, human.

Yet they still have one of the most important roles in helping people in their times of need, often second only to that of the patients themselves. And their opinion, words and messages are more often than not held in the highest regards by those who they're caring for. They're the professional. Of course their opinion matters. 

In my case, I held my doctor's words in the highest regard. He was the one who knew about my condition, the one who was guiding my treatment, the most vital part in my battle with cancer. And, if you've seen my last post, you'd know that I'd managed to see his words in another light to manufacture my own hope.

But not every patient will be able to do that. 

Some will resign themselves to believing that a bad prognosis or survival chance is equivalent to certain death. They may believe their life is cursed by their chronic condition, or that they're inferior and inconsequential because of their learning condition.

Being a doctor isn't only about treating a condition.

You, as a doctor, have a position of power over someone who is at their most vulnerable. You're often the one they trust the most, the one they truly believe, if only because you know more about what's wrong and how to fix it than they are. You therefore have a duty to help them out emotionally and mentally as well as physically. And to do that best, you should help them past their despair and try your best to make them happy beyond that.

You could be the only one who can do that. 

You should remember to be honest. You can't, and shouldn't make up stats or figures or make blithe statements to deceive a patient of their condition. You owe that to them, and yourself. 

And you've got to understand that some people just won't make it.

And that if it comes to that, they have to know.

No-one is immortal.

But how do you hit that balance between giving hope and deceiving someone?

It's not easy. Remember each person is different. And that some will not, or cannot, make themselves accept their disease and move past it. But that shouldn't stop you from trying to pull a patient out of their angst and misery after they've heard bad news. 

You won't happen able to impart hope straight away. They are likely to go through the 5 stages of grief - denial, anger, bargaining, depression and acceptance, even if they haven't been given a death sentence. I know I did in my condition and I've seen it in others with different diseases to me in my life too. You have to try to get them past that before you can start to give them hope, or happiness.
Maybe you could try referring them to a psychiatrist. Maybe you could remind them of the things on their side - perhaps, like in my case, their youth or things like their faith or support network. Maybe you could remind them of their usual optimistic outlook, of their beautiful personality or even of their stubbornness and why that person wouldn't be letting a little disease or condition pull them down. Maybe it's as simple as giving them someone to talk to - someone to understand them. 

Or maybe you won't have to do anything. Maybe you can't. They may, like me, come around themselves or with the help of those close to them. They may be unable or unwilling to put their grief behind them. 

In the end, you've still got to try. 

But your responsibilities as one who may have the biggest impact on how they deal with their disease go even further than just getting them past their misery.

After getting through those 5 stages, I believe there's another stage a person can achieve. But unlike the other five, not everyone will go through it. The best word I could think up to describe it is optimism. But it's not perfect, as it can imply it's only about someone believing they're going to get better.

 As a someone who they trust, you should be trying to move them there too. 

That's where it gets hard though. You mustn't make them think that they're cured, or will be 100%, or that they will have a completely normal life afterwards or that there wouldn't be pain to come in the future. But you have to convey to them that it doesn't mean that they can't be happy, or at least content in their struggle, or in their acceptance of fate. And if they do have a chance, you'll want to give them hope that they're going to get better.

But how do you do this?

First of all, be honest to them.

Remember, you can't and shouldn't kid them. But once they've accepted their diagnosis, try to make them see their new life from a different, more positive perspective. 

Remind them that it's your job to tell them the truth, no matter how hard it may be. But then make them realise that they'd give themselves the best chance of surviving, or leading a normal life or just being happy by being positive about their circumstance. The placebo effect isn't considered in all medical trials for nothing. It may not always save someone from their fate, but it's definitely able to increase their chances. And, logically, if they could give themselves that chance, then they should try. Remind them that even a 10 - 20% chance is still just that - a chance. And they should do everything they can to be in that group of people who survive, both mentally and physically.

Remind them that statistics don't mean anything to an individual. It doesn't consider your personal circumstances. They may have things on their side health-wise that others who made up that statistic or chance didn't like their youth or a more promising prognosis on their particular disease. Even if they don't, they will always have something on their side emotionally. It can be hard to see that. But you can help them understand that there will always be another way of looking at their condition.
Yes, they may have diabetes now and have a chance of developing complications due to it later in life. But when they change their lifestyle, eating habits and start to exercise, they will have a lower chance of developing metabolic syndrome or other diseases. Yes, their broken leg may stop them from work, school or sports in the short term, but it will allow them to really focus on their studies, career, kids or relationships more intensely than they could when they were healthy. Yes, their battle with addiction may be hard, but will turn them into a stronger, more happy individual when they get through it. 

And no matter how hard it may seem, if you help them acknowledge that it will be hard, but reassure themselves of the features that will allow them to get through it, they will not be stopped by obstacles in their journey as they know what to expect and know that it can't stop them. 

Even if they don't want or can't find it in themselves to see their disease in another way, get them to wonder why they should be sad or depressed because of it. They're only harming themselves by doing that. And remind them that they can make the most of life no matter what their condition. Even if they're dying. 

It won't be easy, it may take weeks, months or even years. And it's not like every patient you'll ever have will want to think that way just because you've burst in, cape billowing in the air currents of hospital air conditioning and pronounced that they've got a chance or can be happy with their lot in life. Some people will not have it in them, or may have been through too much to see it in another light. 

But your words will likely have more impact than a lot of others in their life. You have a duty to try. Even if sometimes you may get hurt. Even if you rarely get the time.

And if your support helps only one person live, or be happy despite their problem in your entire career, then you'll be glad you did it. <-- If you or a loved one needs help or if you enjoy my blogs or if you're interested in medicine, like this page on facebook =]


  1. Your blog is amazing, thanks for sharing it. I am particularly taken by the idea of "content in their struggle", it's a beautiful turn of phrase.
    I am very, very glad to know there will be doctors like you in the world.

  2. Your blog is very moving and very well written. As a health professional who has experienced devastating illness you have so much to offer - to your colleagues and to patients. I absolutely agree with you that doctors should be totally honest without destroying all hope. As you say, an optimistic approach greatly increases chances of recovery (miracles do happen) but also makes a huge difference to the quality of life even if the outcome is the same. Thank you for sharing and I look forward to following your journey. Blessings <3

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