The Eagles remind me of long car journeys to France listening to tapes of my parents choosing and being given mental arithmetic challenges to pass the time. “If we are traveling at 75mph and it’s 375 miles to go until we are there, and we are going to stop for an hour, when will we be there?”. What fun! Now children watch DVD’s in the car- though not mine I hasten to add- I have a low opinion of that, regardless of the length of the journey.
I want to talk about lying to patients. Last week I was instructed to tell a patient that she must wait until 5pm to get her biopsy results from the consultant himself, which I happily did. I told her I hadn’t seen the result, which was true I hadn’t seen it, but I knew she had metastases and that the biopsy was positive. It was a small lie, one I was happy to do as at 5pm her husband was coming, the specialist nurse and my bad news bearing boss and crucially it was 4pm when I was lying to her.
My moral judgement was that this little lie was the right thing to do.
On the same ward under a different consultant was another man awaiting bad news, the worst news in fact. He is young, under 50 and has inoperable advanced cancer with weeks to live. He had been told that his treatment plan would be made at the MDM, this is in-spite of his CT being suitable for an undergraduate exam question it being so obviously bad news, but the consultant was postponing the bad news. I was at the MDM, I knew he was for palliative care only and I met the patient in the corridor a few hours later. I told him I hadn’t been at the MDM and hadn’t seen his consultant yet so didn’t know the outcome. (MDM is a multi-disciplinary meeting of surgeons, oncologists, radiologists specialist nurses, etc)
Fast forward to the ward round at 5pm, his consultant still hasn’t been to see him, he is sitting with his ashen faced wife, waiting. I phone him before I start and ask if I can tell him the news, he says no. He says he will come later and do it which of course he fucking doesn’t do. The next morning the patient isn’t in his bed at the 8am round so I have a reprieve, he’s away for a fag.
We are now almost 2 days from the MDM, it is the evening ward round, he is again in bed and again has his wife with him. I phone my boss (who I now really hate) and I have the specialist nurse with me, who is furious too and I ask him if I can just tell the man. Again he says no, he says he will come later.
The man, who I have known a few weeks, says “it’s bad news isn’t it, that’s why he is avoiding me”. I tell him I think he should prepare himself for that possibility, that my boss is too busy just now but he will come soon. Then I tell him that I am very sorry about that, that I have tried to make him tell him sooner, that I would like to give him the information he needs but my boss has said he will come that evening and he wants to speak to him himself. He came the next morning, when his wife was gone, the specialist nurse was gone and he finally told him the bad news and discharged him from hospital.
What is the difference in the two lies? Morally none at all, I lied in both instances but in the case of my palliative man, I felt I was contributing to torturing him and his wife in withholding this information. I nearly went over Mr Avoiding Things head but I was too cowardly to disobey him, even though I thought it was wrong. Ultimately he isn’t my patient, but the specialist nurse was egging me on to do it, the ward nurses were and I couldn’t look the man in the eye and keep lying to him.
It was torture for that man and his wife to wait 3 days to be told he was completely fucked. It was cruel anyway to let him think he had a chance at surgical cure in my opinion but that is this particular boss’s style to string them along until they’ve been MDM’d and then seem all surprised and sorry and that it’s a shame he won’t get to save them.
The GMC (who’s advice I blatantly ignore in having a pseudonym for this blog) say that I should be honest in my dealings with patients but don’t specifically go into the shades of grey that are lies of omission, delays in telling bad news etc.
My own prejudice in this is that the first consultant is a pain at times but generally is one of life’s good guys and he cares about his patients more than anything else. This meant that I was happy to lie for him because I genuinely thought it was in the best interests of the patient. Mr Avoiding things is not a great leader and never will be, he has a nasty habit of losing the plot in theatre and if I met him in a psychiatry clinic I would give him lithium.
I don’t even know what my point is in writing this, I can do nothing about it, I am too cowardly to confront my (frankly unapproachable) mad as a stick boss and morally I have no issue lying to patients when I think in my patronising and paternalistic way that it is “for the best”. I suppose I just want to say sorry to the man and his wife for the part I played in making the worst week of their life even more painful than it had to be.
This man will probably end up back in with us as his illness progresses, hopefully we can get it right then.