A patient is critically ill and his or her family is hanging on every word the doctor utters about their loved one's condition and outlook.
In such a situation, how realistic should the doctor be?
Studies have shown that doctors are sometimes hesitant to provide the family with a realistic appraisal of a critically ill patient's prognosis.
They are reluctant to take away the hope that their family member will survive. They want them to be able to maintain some semblance of hope.
But is this an example of doctors assuming too much responsibility and power? Although well-intentioned, not providing a realistic picture maybe detrimental to the family.
What are the wishes of the family whose family member is critically ill?
To answer this question, researchers interviewed 179 family members of critically ill patients who were on ventilators in an intensive care unit.
They were questioned concerning how much information they should receive. The results of the study showed that the vast majority of family members believed holding back any information was unacceptable.
They believed that a well-timed discussion in which a realistic prognosis is provided is necessary and vital so they could not only be emotionally prepared for the likelihood of their loved one's death, but be able to make the necessary practical plans.
Most family members believed they were strong enough emotionally to manage the bad news.
But this is not always the case. For example, what if the patient's spouse is so distraught that it is obvious she or he is not able to emotionally or physically manage such grim news?
And, at times family members are divided concerning how much information should be given to the patient or a grieving family member.
The researchers of this study tried to provide some general guidelines for these difficult situations. They recommended the role of the doctor should be to help families "hope for the best, but be prepared for the worst."
Sounds like good advice but this is not always easy to do.
Massachusetts-based Dr. Murray Feingold is the physician in chief of the National Birth Defects Center, medical editor of WBZ-TV and WBZ radio, and president of the Genesis Fund. The Genesis Fund is a nonprofit organization that funds the care of children born with birth defects, mental retardation and genetic diseases.
