Even if you have never seen the movie, A Few Good Men, most of us have heard the Jack Nicholson line,
“Truth? You want the truth? You can’t handle the truth!”
A recent study identified truth as one of the top needs of patients facing the end of life. For years, medicine has taken the Jack Nicholson approach, and been paternalistic. You can’t handle the truth, so we’ll just keep doing treatments and hope you don’t notice that you are getting weaker and more frail.
In defense of doctors and caregivers who have acted this way, the thought process was actually that they didn’t want to take away a patient’s hope, so they continued to offer more and more treatments. It turns out truth is a better option for a lot of reasons.
Hope is a Complex Thing
Now, hope is a complex thing. What we sometimes seem to think is that the only hope a patient has is for a complete cure, and if we bring up the subject of death, patients will give up.
Families often buy in to this mindset, or even promote it by asking the doctor to only tell them about what is going on, and not to tell the patient. Culturally, that may be appropriate for some, but more often it is that conspiracy of silence, wherein the family thinks the patients doesn’t know how sick they are, and the patient doesn’t think the family knows how sick he/she is, and until someone actually names it, each goes tip-toeing around the other.
I have even heard of patients who don’t openly discuss being near the end of life with their doctors out of a desire to not upset the doctor! As one patient told me when I announced that her doctor had referred her to hospice, “Well it’s about time he admitted that I’m dying!”
Treat Me Like a Person and Tell Me the Truth!
In the study I mentioned above, the two highest ranking items of spiritual needs were…
- Being treated like a person
- Being told the truth.
Hope was there, but much farther down the scale. People would rather know the truth, and be able to face it and plan for it, than to be given a hope in a lie. A false hope is worse because it keeps us from dealing with things we’d want to do if we only knew.
The “Lottery” Mentality
I know some doctors who tell me that patients all want every new treatment out there. They research and ask, but really, are they asking for that treatment, or an honest opinion of whether the doctor thinks that might be something that really could work, or is it just a pipe dream?
To be sure, there are some patients who live on what I call the “lottery mentality”. To describe this scenario, think of the last time the Mega Millions lottery got to a ridiculously large number. It seemed everyone and their brother were buying tickets.
Some folks buy tickets no matter what, and both seem to have the concept that “somebody wins.” When you buy a ticket, you often dream of all the things you’ll do if you win. However, unless you are totally blind and naive, you don’t quit your job before the winning numbers are drawn. You dream of winning, but you plan for not winning, which is by far the more likely scenario.
Sometimes in medicine, those with the “lottery mentality” actually quit their jobs, so to speak, by not focusing on the necessary and important aspects of their own lives, but putting all their energy in to that lottery.
Tragically, somebody may win, but more likely than not, it won’t be them. And by the time they realize it, they’ll have lost a precious opportunity, one they can never get back. Shame on us for allowing that to happen in the name of so-called hope. The real hope is for an honest doctor, an honest companion on the journey.
The Bottom Line
The bottom line? Open discussion is the way to go. Honest communication does not have to be gloom and doom, even if the outlook is horrible. Honor patients as persons and give them the truth.
Jack Nicholson was wrong. We not only CAN handle the truth… we DEMAND it.