Lee C. Zhao, MD, Gaines Blasdel, Augustus Parker, and Rachel Bluebond-Langner, MD
Tension between realistic goals and unrealistic views about how to achieve them is compounded when patients are eager to revise a prior surgeon’s gender-affirming procedure.
AMA J Ethics. 2023;25(6):E391-397. doi:
10.1001/amajethics.2023.391.
A physician discusses how medical students should handle an interaction with a patient who has not yet received information from the physician regarding test results and their implications.
The physician must help patients understand that all options—further testing, surgery, no action—carry risks and benefits. Disclosing the statistical probability of injury and other possible outcomes might help, but it can also hinder the process.
After assessing the reasons for a patient’s unrealistic hopefulness in the face of clear understanding, a clinician may believe that significant harm will come to the patient if he or she does not acknowledge the seriousness of the illness.
One strategy is to determine “triggers” that alert the primary clinician that the patient has a high symptom burden or difficulty coping with the diagnosis, prognosis, or treatment plans and should be offered palliative care services.
There is evidence that children who are unaware of their life-threatening diagnoses do not experience any less distress and anxiety than those who are told, and in some cases they may actually experience more.