It has long been a part of medical tradition to give the patient any possible bad news as soon as the opportunity arises. I think this needs to be balanced with giving the patient every bit of evidence of good news as well. When a patient arrives at my office with a "tummy ache" I can warn them of the possibility of cancer, dissecting aortic aneurysm and every other possible scary diagnosis. I could also skirt my responsibility by saying "It's probably nothing." Both approaches are weak medicine. There is a better way to approach a patient that is infinitely more satisfying to both the doctor and the one who seeks their assistance. I call it "Speaking Life."
The majority of problems that a generalist physician sees are self-limited, meaning they resolve easily through the power of the body's intrinsic healing mechanism. Some are less likely to clear up on their own. Many of these would be much more likely to proceed to complete healing if the stress of fear-motivated warnings were mitigated with a little common sense. The fear of lawsuits, missing a diagnosis or just looking "dumb" drives many doctors to make a list of the worst possible illnesses just to "cover their backsides." Though this may look wise on the surface of things it can significantly reduce the opportunity for the body's systems to take the appropriate action to kill infection, remove tumors or open up blood vessels. The brain and central nervous system respond to stress by turning down the immune system and turning up the production of adrenaline and steroids. Eventually this results in bad results if taken to the extreme.
On the other hand, a really great doctor tells the patient the whole truth and lets them know that there is much more to healing than simple statistical analysis. Though the diagnosis and treatment of illness are a critical part of good care, the management of stress related to the interaction with the health care system rests partially on the shoulders of the physician as well. If a disease with a very poor prognosis is discovered it is prudent to remember that small percentages of patients with the worst conditions get well. Why shouldn't patients be reminded of this possibility along with the grim statistics? The immune and nervous systems work together to heal the body and it's part of a doctor's job to recognize this relationship and "Speak Life" while the business of medical treatment marches on. Hope is a powerful treatment for any illness when it's based on the truth!
