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Editor - Three cheers for Kitty McCague of Washington (BMJ 28.4.01
letters). Partly because of her clinical circumstances and partly because
of her freedom from the institutionalised thought processes of us doctors,
she summarises concisely, unemotionally and with authority the concerns
which many of us have about some aspects of oncology. O'Rourke et al
state that 'false optimism as reported is not a problem that needs to be
overcome'. Those of us, mostly in primary care, who have to absorb the
distress caused by repeated expressions of false optimism, often in the
face of overwhelming clinical evidence, would disagree strongly.
If in the course of consenting a patient for an operation, a surgeon fails
to tell a patient that it has only a 20% success rate, he might well be
considered negligent. Many chemotherapy treatments confer benefit on an
equally small proportion of their recipients, the remainder being arguably
worse off. What gives any of us, be we surgeons or oncologists, the right
to avoid giving facts with honesty? Many of us hoped that paternalism had
disappeared years ago, but it is self evident that it is alive and well,
disguised as keeping the patient's spirits up to the bitter end. Patients
are not stupid, and have the right to make decisions, especially momentous
ones, for themselves in the knowledge of all the facts. They and their
relatives become understandably disillusioned and angry, however, when
they are mis-led, however altruistic the motive. We would all do well to
learn from Ms McCague.
Collusion in doctor-patient communication
Editor - Three cheers for Kitty McCague of Washington (BMJ 28.4.01
letters). Partly because of her clinical circumstances and partly because
of her freedom from the institutionalised thought processes of us doctors,
she summarises concisely, unemotionally and with authority the concerns
which many of us have about some aspects of oncology. O'Rourke et al
state that 'false optimism as reported is not a problem that needs to be
overcome'. Those of us, mostly in primary care, who have to absorb the
distress caused by repeated expressions of false optimism, often in the
face of overwhelming clinical evidence, would disagree strongly.
If in the course of consenting a patient for an operation, a surgeon fails
to tell a patient that it has only a 20% success rate, he might well be
considered negligent. Many chemotherapy treatments confer benefit on an
equally small proportion of their recipients, the remainder being arguably
worse off. What gives any of us, be we surgeons or oncologists, the right
to avoid giving facts with honesty? Many of us hoped that paternalism had
disappeared years ago, but it is self evident that it is alive and well,
disguised as keeping the patient's spirits up to the bitter end. Patients
are not stupid, and have the right to make decisions, especially momentous
ones, for themselves in the knowledge of all the facts. They and their
relatives become understandably disillusioned and angry, however, when
they are mis-led, however altruistic the motive. We would all do well to
learn from Ms McCague.
Dr T R G Howard
Woodside Farm, Corfe Mullen, Dorset
Competing interests: No competing interests