You may delay, but time will not. - Benjamin Franklin
A few weeks ago, a tweet popped up in my feed. I meant to save it, but I didn’t. Basically, a cancer surgeon was begging the doctors who make the diagnoses to tell their patients when they have cancer. It makes the surgeon’s ensuing conversation pretty awkward when they don’t. At the time, it seemed like an aberration. People don’t really do that, do they? That would be too cruel. But now, as the administration repeatedly downplays the seriousness of the novel coronavirus, it seems like it could more common than I thought.
It can’t be easy giving bad medical news. In fact, I imagine that it is one of the hardest things a person can do – telling someone, even someone they don’t know well (especially someone they don’t know well?) that their lives are going to change for the worse, they won’t live as long as they thought, or they won’t live for very much longer. Or even worse, delivering one of those things about a person’s child. It must come with a burden of anxiety, and even some fear about how the patient will react. I’m happy to say I never took my fear out on a provider (a customer service person, yes. But only once, and I apologized immediately, and sent his company a letter with how well he did when faced with my outburst.), but I’m sure it happens. Fear and anxiety are not reasonable. Even if a patient knows it’s coming, lashing out at the nearest target would not be a surprising reaction. Not right, but not surprising.
The thing is, when we as patients are not told about how serious our life has just become as soon as we should, the person choosing to delay or soft-pedal is acting as though they are more capable of making the hard decisions about their patients’ bodies than the patient is. Even if that were true, and it’s usually not, it’s not their job. They take away our agency when they do that, and our most basic right - to make informed choices for ourselves. I’ve had medical professionals do this to me. The first doctor who treated my diabetes (a pediatrician with some experience with diabetes – far from a pediatric endocrinologist) used to send me out of the room to discuss treatment with my parents. Yes, I was 14, but that is plenty old enough to at least have a say in my own treatment. It didn’t feel good, and he didn’t last long.
That’s not to say doctors who have done this were doing so out of malicious intent. I know the instinct likely comes from a deeply ingrained desire to protect and to heal, but by not being upfront about our lives, a provider could do harm. Earning the trust and confidence of a patient is already a difficult ask, depending on how they’ve been treated by the healthcare system, and delaying or not delivering bad news, for whatever reason, erodes that even further. In addition, some conditions require fast action. Even that space between when the physician with the information leaves and the cancer surgeon comes in can be enough to brace yourself, calm yourself, formulate questions, and better prepare for the next step.
No matter when the bad news is delivered, it doesn’t change what is. So, just tell us. We are grownups. The likelihood that we have dealt with bad news before is high, even if it doesn’t quite rise to the level of a mortality-reassessing condition. I promise you, we’ll be ok. Better if we are able to hold on to some measure of control. We appreciate the sentiment behind it, but as the great man said, you may delay, but time will not.