A surgeon argues passionately for doctors to notify cancer patients of their condition so they can make informed treatment decisions.
Papachristos (Differential Clinical Significance of Medical Information, 2016) has been the head of thoracic surgery at Greece’s 424 Military Hospital since 1999. He translated this book into English himself, with the assistance of editor George A. Rossetti. In his 32 years of clinical experience, he has developed a deep compassion for those with life-threatening conditions. But he notes that Mediterranean countries, including Greece, have had an unfortunate track record of withholding bad news from patients. In some situations, nondisclosure has even been “justified as a courtesy”: The author cites the example of England’s King George VI, who had no idea he had cancer when he underwent lung surgery in 1951. It is essential, the author argues, for patients to know the whole truth about their cancer so they can give informed consent for procedures. “We are duty-bound to disclose information we know to be true,” he insists. Practical chapters give useful, step-by-step advice on how to break bad news, even giving sample scripts for multiple sessions. In a first meeting, Papachristos suggests, cancer should not be mentioned, but body language cues can begin to prepare the patient. A second session will ready them psychologically; the third will feature “full frank disclosure” and an emphasis on what treatments are available. If time is short, two of the sessions can be combined. Later sections deftly discuss how to inform family and caregivers and decide on pain management. Most chapters open with vivid italicized case studies in which patients were kept in the dark; the author’s principles could have reduced heartache. The book is at times overwritten, with overabundant exclamation points and some moral simplification (for example, attributing the financial crisis in Greece to “poverty that generates nagging greed in the hearts of the wicked”). The writing is not wholly colloquial, with a tendency toward redundant or awkward phrasing and wordiness (“All too often, physicians hypocritically state publicly that they vehemently oppose disclosing cancer diagnoses to their patients out of a professed love and care for them, lest they cause them any distress”). But these minor infelicities of style can be overlooked because the contents are overall so helpful and down-to-earth.
A valuable plea for honesty between medical professionals and their patients.