SHOULD WE DISCUSS "BAD NEWS" WITH CHILDREN-
a real life experience
We often come across younger patients especially children who are diagnosed to have illnesses with relatively poor outcomes. These may include a child diagnosed to have cancer of blood (leukemia) or cancerous tumor of brain (glioma), etc, which could prove fatal in some cases. In our normal medical practice, we discuss in detail about the disease with the patients and immediate family members. Areas of discussion involve the nature and likely progression of disease, the likely causes of the disease, the different modes of treatment (including cost of medicines or surgery, as the case may be) and the expected outcomes of disease & treatment.
In case of children, parents often tell us not to share any medical details with the child, fearing the child would get depressed or anxious or they won't be able to handle the "bad news" and many other excuses. Sometimes, we are asked to tell a lie to the child- for example, in stage IV glioma of brain, the expected survival could be 6 months to 12 months. In this scenario, parents usually ask us to tell the child that "he does not have tumor" and that "there is no risk to his life because of the illness".
Are we justified in not sharing medical details (bad news) or distorting the facts to child patients?
I want to share an experience that I recently had.
An 8-year-old child Arjun was referred to me by the oncologist for control of convulsions (fits). Arjun was diagnosed to have grade IV (late stage cancer) glioma of brain and was receiving chemotherapy after having undergone a brain operation. In my OPD, Arjun's parents met me first and requested me not to disclose anything about the illness to him, including the diagnosis and likely outcome, and lie to him that "he will be well soon". They told me that Arjun does not know anything about his illness or its outcome. I told them I would do what they expected of me.
When parents brought the child in, he looked very calm and composed. He was on a wheel-chair as he could not walk due to weakness of legs (nerves in brain that send signals to legs were damaged by the brain tumor). He had a beautiful smile on his face. While interacting with him, I found him to be very intelligent and smart. I asked his parents if I could privately talk to Arjun and they agreed. As soon as his parents left the room, Arjun told me he knows everything about the illness. He had read the doctors' medical notes and then browsed the internet to find out more about his illness. He told me that he has grade IV glioma and that at the best, he would survive for six months. He told me not to disclose to his parents that he already knows everything about his illness; otherwise they would feel "hurt".
Next I sent Arjun out and told his parents about the interaction I had with the child. They stood speechless and expressionless. They were shocked! Here, we had a family living in denial....that the other party does not know anything!.
Today, obtaining information is easy to get. One can get all desired information about a disease with a few clicks on the internet. So, hiding information from a child is not so easy. On the other hand, I feel sharing all details over 2-3 meetings is more appropriate. It is more important in situations where the child has a terminal illness. The child can be allowed to spend a quality time with family and friends and be allowed to fulfil any of his wishes during that period. In my clinical practice, I prefer to tell everything about the illness to my patients- old or young, men or women....unless, of course, they don't want to know (which is very rare).
(Arjun is the changed name to hide identity of the patient)
Dr Sudhir Kumar MD (Medicine) DM (Neurology)
Consultant Neurologist
Apollo Hospitals, Hyderabad, India
Phone: 0091-40-23607777/60601066
Email: drsudhirkumar@yahoo.com
a real life experience
We often come across younger patients especially children who are diagnosed to have illnesses with relatively poor outcomes. These may include a child diagnosed to have cancer of blood (leukemia) or cancerous tumor of brain (glioma), etc, which could prove fatal in some cases. In our normal medical practice, we discuss in detail about the disease with the patients and immediate family members. Areas of discussion involve the nature and likely progression of disease, the likely causes of the disease, the different modes of treatment (including cost of medicines or surgery, as the case may be) and the expected outcomes of disease & treatment.
In case of children, parents often tell us not to share any medical details with the child, fearing the child would get depressed or anxious or they won't be able to handle the "bad news" and many other excuses. Sometimes, we are asked to tell a lie to the child- for example, in stage IV glioma of brain, the expected survival could be 6 months to 12 months. In this scenario, parents usually ask us to tell the child that "he does not have tumor" and that "there is no risk to his life because of the illness".
Are we justified in not sharing medical details (bad news) or distorting the facts to child patients?
I want to share an experience that I recently had.
An 8-year-old child Arjun was referred to me by the oncologist for control of convulsions (fits). Arjun was diagnosed to have grade IV (late stage cancer) glioma of brain and was receiving chemotherapy after having undergone a brain operation. In my OPD, Arjun's parents met me first and requested me not to disclose anything about the illness to him, including the diagnosis and likely outcome, and lie to him that "he will be well soon". They told me that Arjun does not know anything about his illness or its outcome. I told them I would do what they expected of me.
When parents brought the child in, he looked very calm and composed. He was on a wheel-chair as he could not walk due to weakness of legs (nerves in brain that send signals to legs were damaged by the brain tumor). He had a beautiful smile on his face. While interacting with him, I found him to be very intelligent and smart. I asked his parents if I could privately talk to Arjun and they agreed. As soon as his parents left the room, Arjun told me he knows everything about the illness. He had read the doctors' medical notes and then browsed the internet to find out more about his illness. He told me that he has grade IV glioma and that at the best, he would survive for six months. He told me not to disclose to his parents that he already knows everything about his illness; otherwise they would feel "hurt".
Next I sent Arjun out and told his parents about the interaction I had with the child. They stood speechless and expressionless. They were shocked! Here, we had a family living in denial....that the other party does not know anything!.
Today, obtaining information is easy to get. One can get all desired information about a disease with a few clicks on the internet. So, hiding information from a child is not so easy. On the other hand, I feel sharing all details over 2-3 meetings is more appropriate. It is more important in situations where the child has a terminal illness. The child can be allowed to spend a quality time with family and friends and be allowed to fulfil any of his wishes during that period. In my clinical practice, I prefer to tell everything about the illness to my patients- old or young, men or women....unless, of course, they don't want to know (which is very rare).
(Arjun is the changed name to hide identity of the patient)
Dr Sudhir Kumar MD (Medicine) DM (Neurology)
Consultant Neurologist
Apollo Hospitals, Hyderabad, India
Phone: 0091-40-23607777/60601066
Email: drsudhirkumar@yahoo.com
3 comments:
It's completely agreeable..
One can't hide himself or herself from the reality..
Nedd to face it someday...
Hello Doctor
I had some of the symptoms of B12 deficiency and got tested. The result show 152 pg/ml. I understand this is below the normal range and I wanted to see a doctor. I see you are in Hyderabad, can you please suggest me a good doctor in Guwahati ?
Hi Piyush, You can meet Dr Partha Sarathi Deb at GNRC, Guwahati.
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