In Act I of Oscar Wilde’s play, The Importance of Being Earnest, Algernon tells us, “The truth is rarely pure and never simple.” I know he wasn’t referring to what it takes to talk with patients about their disease, the treatments, the side-effects, what it takes to have to deliver bad news, but he might as well have been!
The truth is such an odd thing, especially when so much of it, as so often happens in our conversations with patients, is tinged with the unknown (and unknowable!). How do we communicate what they need to know about their disease and its progression when we can’t always be sure of what’s coming? Or when we are fairly sure that what’s coming isn’t going to be pretty?
Communicating with patients is never simple, and the truth is often hard to pin down, but we owe it to our patients to do our best to help them understand the truth of their situations along the way, at least as best we understand it!
The truth, even when it’s ugly or hard or sad, is a reality that patients can choose to accept or reject. When we gently tell them what’s “really happening,” we empower them to deal with it fully -- to fall apart if they need to, to rage or grieve, to ignore it or to come to peace with it. Whatever they do with it, it will be their choice, and that is an incredible gift of trust that only the medical team can share.
The truth about telling
In my conversations with medical teams over the years, it always strikes me that while most folks get this, while most folks agree that telling the “truth” is important, when push comes to shove and a frail, vulnerable patient is sitting before them, it can be awfully tough to trust that it really is more helpful to speak honestly. However, half-truths and unclear information don’t offer anything for a patient to grab onto, to work through, or to fight against.
We have to remember that our patients feel safer when they believe in their teams, when they trust us, and when they know that we are telling the truth.
We have to remind ourselves that trust is one of the basic healing elements in our relationships with our patients, especially when things are going poorly. When patients find that what they are already feeling and fearing in their bodies is recognized, understood, and honored by the folks who “should know” (the medical team) a foundation of trust is established. It is this foundation of trust that offers comfort in a way that almost nothing else can. And nothing builds trust like compassionately delivered truth.