[MOL] difficult topic, article #2 [00073] Medicine On Line


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[MOL] difficult topic, article #2



Collusion in doctor-patient communication about imminent death:
    an ethnographic study
    [12/01/2000; British Medical Journal]

"False optimism about recovery" usually developed during the (first)
course of chemotherapy and was most prevalent when the cancer
could no longer be seen in the x ray pictures. This optimism
tended to vanish when the tumour recurred, but it could develop
again, though to a lesser extent, during further courses of chemotherapy.
Patients gradually found out the facts about their poor prognosis,
partly because of physical deterioration and partly through contact
with fellow patients who were in a more advanced stage of the
illness and were dying. "False optimism about recovery" was the
result an association between doctors' activism and patients'
adherence to the treatment calendar and to the "recovery plot,"
which allowed them not to acknowledge explicitly what they should
and could know. The doctor did and did not want to pronounce
a "death sentence" and the patient did and did not want to hear
it. 

Conclusion: 

Solutions to the problem of collusion between doctor and patient
require an active, patient oriented approach from the doctor.
Perhaps solutions have to be found outside the doctor-patient
relationship itself, for example, by involving "treatment brokers."

The full article can be found at:

http://www.bmj.com/cgi/content/full/321/7273/1376?ck=nck

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