Mennonite Church Canada logo
Location:
News » Releases » Cultural approaches to honesty in medicine
 

Cultural approaches to honesty in medicine

   
 


Advanced English students at Chongqing Medical University discuss how honest one should be in delivering bad news to patients. Photo by Philip Bender

View or download full sized image.

   

May 12 , 2009
-Philip Bender

CHONGQING, China — I recently invited one of my Advanced English classes of doctors to discuss the proverb, “honesty is the best policy.” Specifically, I wanted to know how candid doctors and families in China are in delivering bad news to a patient.

To find out, I assigned my five students a role play which involved a female patient, her husband and daughter, and two doctors. As the play opens, the doctors have just diagnosed the patient with a malignant tumour. They are about to speak with the patient and her family.

Patient: “I want to know what is wrong with me.”

Doctor 1: “You are sick. The X-ray showed a shadow on your lung. We’re not quite sure what it is, but you may need surgery. You need to come back with your husband.”

Patient: “But can’t you tell me more?”

Doctor 1: “We’re not sure what you have, but come back with your husband.”

Doctor 2: “It could be tuberculosis, it could be pneumonia, it could be a carcinomic nodule. We’ll need to do more tests, and probably surgery. But don’t worry, the surgery will relieve your problem.”

Then the doctors meet the woman’s husband and daughter, alone.

Husband: “What is wrong with my wife?”

Doctor 1: “She has a malignant tumour on her lung. And the survival rate for this kind of tumour is 50% after one year.”

Husband: “What can you do?”

Doctor 2: “We can operate, but the chances of complications are high. And her survival chances are low.”

Father and daughter now confer.

Father: “I think we need to tell mother directly what is wrong. She can handle this.”

Daughter: “I disagree. She’s not strong enough. Let’s just tell her she needs surgery.”

They go to their mother. Father and daughter speak with Mother.

Husband: “You have a shadow on your lung, and need surgery. But you will be relieved.”

Daughter: “Yes, you will be fine.”

We then debriefed the role play. “Why weren’t you as doctors, and as family members, more honest and direct in telling this woman her diagnosis?” I asked. “Especially since she wanted to know the truth about her illness.”

The students’ responses provided some insight to their hesitation:

If we tell patients bad news, they will give up hope and die.

Maybe the patient will commit suicide, and then family will blame us.

The government has rules against doctors telling patients bad news directly. We are allowed to tell the families, but not the patients.

We sometimes tell the patient – if they are strong – but usually we just tell them that they will get better because we don’t want them to give up hope. Patients’ families often do the same.

Chinese medical law is ambiguous about such situations. It states, “The medical establishment and personnel should honestly inform the patient of the state of illness, medical measures taken and relative medical risks, and reply to the patient’s inquiry promptly. However, any unfavourable influence on the patient should be avoided.”

After the students shared their perspectives, I told a story from my own experience. Shortly before Christmas, 1969, a doctor entered my father’s hospital room to share the news that Dad was diagnosed with liver cancer and might only have six to twelve months to live.

The students wondered how my father took the news.

“He took it bravely,” I replied. “He just said, ‘That’s not the news we were hoping for.’”

I added that three weeks later, my father died. “I’m still glad the doctor was honest. It gave us as a family a chance to have some serious conversations with him about his life, and about what lay ahead, and to prepare for his death.”

Our English classes provide a good forum for cross-cultural discussions. Through this particular class, I have become more aware of the cultural differences between doctor-patient relationships in North America and China, and what “honesty” in certain situations does and does not mean. I have also realized again how delicate the subject of death is for our students, even for skilled professionals like doctors.