28 Apr 2017

Delivering the truth to patients

From Nine To Noon, 9:40 am on 28 April 2017
male doctor tends female patient

Photo: 123rf

Medical professionals need to balance their patients' right to hear the truth with their own obligation to convey information with sensitivity, palliative care specialist Dr Anne O'Callaghan says.

She tells Nine to Noon's Kathryn Ryan the ability to have difficult conversations with compassion should be part of a doctor's skill set.

A diagnosis can sometimes be a relief as an end to uncertainty, but a terminal prognosis can be much trickier to deliver with sensitivity, Dr O'Callaghan says.

These conversations often happen in hospital after an emergency incident, so often it's someone who doesn't have a pre-existing connection with the patient delivering the news.

To guard against overwhelming a patient, it's necessary to have a sense of them as a person, she says.

Asking and listening can be a guide to how much they need to hear and at what rate.

"I might say to somebody 'I know you've been through a lot. Can you tell me what you understand about where things are at now?' I've got a lot of things I could say in my head, but I don't know where they're at, I don't know what they know, and I don't know what to build on."

Shock can block our ability to think clearly, says Dr O'Callaghan, and there's no point ploughing on with difficult news or information when a patient can't take it in.

"I say to people 'Good communication saves you time'. If you're going to deliver ten minutes of information about where we're going to go from here and that person hasn't heard any of it, you're wasting your time."

Medical professionals should also be sensitive to how the illness is being managed within the family, she says.

"How does it work in your family? What will work for you? If we've got news we need to discuss how do you want us to do that? Who do you want to be there? Who do you want us to talk to?"

In the last ten years, there has been a lot more open dialogue within the medical profession about how best to have these conversations, Dr O'Callaghan says.

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