Query on &quot;Good Medical Practice&quot;

Original post by park1996

Hi everyone.

I was browsing through 'good medical practice' document and I found an interesting point in the Consent guidance: Reasons for not sharing information with patients section. Here it is:

16. You should not withhold information necessary for making decisions for any other reason, including when a relative, partner, friend or carer asks you to, unless you believe that giving it would cause the patient serious harm. In this context ‘serious harm’ means more than that the patient might become upset or decide to refuse treatment.

Now I'm a bit confused - I thought a Doctor must inform a patient completely about, for example, a treatment method/the condition they have?

Could someone clarify this please?

Thanks in advance.

You need to bear in mind (or be aware) that in the somewhat recent past, it was fairly normal for doctors to withhold a serious diagnosis (ie. a terminal one) from a patient, since it was deemed to not be in their interest to find out. This has obviously changed now, but there is still a little bit of leeway for a patient to tell the doctor that they don't want to hear what's wrong with them, and for the doctor to respect that. There are rather nuanced rules about when the doctor should ignore this wish of the patient, eg. if it's cancer that requires chemo, the chemo has risks/side-effects significant enough that the patient ought to be informed of the diagnosis so they can make an informed decision as to whether it's worth it to them.

Reply 3

park1996

OP

2

Original post by Ronove

You need to bear in mind (or be aware) that in the somewhat recent past, it was fairly normal for doctors to withhold a serious diagnosis (ie. a terminal one) from a patient, since it was deemed to not be in their interest to find out. This has obviously changed now, but there is still a little bit of leeway for a patient to tell the doctor that they don't want to hear what's wrong with them, and for the doctor to respect that. There are rather nuanced rules about when the doctor should ignore this wish of the patient, eg. if it's cancer that requires chemo, the chemo has risks/side-effects significant enough that the patient ought to be informed of the diagnosis so they can make an informed decision as to whether it's worth it to them.

I understand that it has changed in recent years, however I still do not fully understand why a doctor would withhold information because this point in the guidelines seems to imply to me that there are circumstances where a doctor still does withhold info.... are they afraid that disclosing information may psychologically affect them?

(edited 9 years ago)

Reply 4

The guidelines are more for when a patient doesn't want to know anything about their condition.
The doctor's will withhold the information if they have reason to believe the patient will harm or kill themselves if the doctor forces the information on them.
An example might be if someone has had a scan for a brain tumour, but refuses to see the results. They tell the doctor that they don't want to know, because if they do have the tumour, they will kill themselves. If the doctor believes this, then telling the patient that they have a tumour will cause serious harm. So in this case, the doctor would not tell the patient at this point.
As it says later in the guidelines, this decision should be constantly reviewed. So it's not saying that the patient will never be told they have a tumour. And I assume the doctor would try to put things in place to support the patient before telling them.

I hope that makes sense. It's that kind of scenario. The doctor should always try to tell the patient everything, but if there is a serious threat to the patient, it's best to hold back for a while.

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Reply 5

nexttime

22

I have to say, I'm pretty confused too. You have to let a patient make an informed decision... unless they might make the wrong decision in which case just don't tell them? Seems legit.

Original post by Zebrajess

They tell the doctor that they don't want to know, because if they do have the tumour, they will kill themselves.

If they don't want to know you shouldn't tell them though. Why would you be telling them anyway?

(edited 9 years ago)

Reply 6

Original post by nexttime

If they don't want to know you shouldn't tell them though. Why would you be telling them anyway?

Because they have to decide a treatment. It says in the guidelines that even if they don't want to know you have to try and tell them enough for them to make a decision. You can't just start operating on them when they don't even know they're ill.

Reply 7

nexttime

22

Original post by Zebrajess

Because they have to decide a treatment. It says in the guidelines that even if they don't want to know you have to try and tell them enough for them to make a decision. You can't just start operating on them when they don't even know they're ill.

So a patient tells you that they do not want to hear their scan result. You're just going to tell them anyway? Do you not see a problem with that?

If they put their hands over their ears will you shout it at them to make 100% sure you broke their wishes?

Obviously if a patient declines to hear a result they ate also declining subsequent treatment. As is their right.

Reply 8

Original post by nexttime

So a patient tells you that they do not want to hear their scan result. You're just going to tell them anyway? Do you not see a problem with that?

If they put their hands over their ears will you shout it at them to make 100% sure you broke their wishes?

Obviously if a patient declines to hear a result they ate also declining subsequent treatment. As is their right.

Obviously you have to respect their wishes, but you have to explain the risks they are taking by not knowing all the information and try your hardest to get them to listen. You can't force it on them, of course they have a right to refuse, but you should also want the best for your patient.
If someone says they don't want to know, you can't just say ok and leave it at that, as you're putting the patient at risk. You have to show you've tried to explain and told the patient the risks of withholding this information

And this doesn't just apply if they don't want scan results. That was one example. Maybe they know they have cancer, but don't want to know about the treatments. They just want you to decide and they'll consent to whatever, they don't want to know the risks because it will scare them.
You shouldn't just do whatever you like to them, you should try to explain to them why they need to know the information and make a decision based on all the facts. But again, no one can force the information on them.

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Reply 9

Ronove

Original post by Zebrajess

Obviously you have to respect their wishes, but you have to explain the risks they are taking by not knowing all the information and try your hardest to get them to listen. You can't force it on them, of course they have a right to refuse, but you should also want the best for your patient.
If someone says they don't want to know, you can't just say ok and leave it at that, as you're putting the patient at risk. You have to show you've tried to explain and told the patient the risks of withholding this information

And this doesn't just apply if they don't want scan results. That was one example. Maybe they know they have cancer, but don't want to know about the treatments. They just want you to decide and they'll consent to whatever, they don't want to know the risks because it will scare them.
You shouldn't just do whatever you like to them, you should try to explain to them why they need to know the information and make a decision based on all the facts. But again, no one can force the information on them.

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How can you decide that hearing the information is best for them if they don't want to hear it?

Reply 10

ForestCat

I think what its also saying is you cannot let families decide what a patient knows. It is very common for a relative to say I don't want my mum/dad/spouse etc to know this because I don't think they can handle it, when its not up to the relative. The patient should always be asked what level of information they want to know.

Reply 11

Original post by Ronove

How can you decide that hearing the information is best for them if they don't want to hear it?

Erm I don't quite understand you.
Hearing their treatment options is surely better than you just choosing one for them with them having no knowledge of the risks and other treatments available.
That's what I was getting at. If they don't want to know, then fair enough, but when possible, you're supposed to let the patient have all the information and decide what they want to do.

Reply 12

ForestCat

Original post by Zebrajess

Erm I don't quite understand you.
Hearing their treatment options is surely better than you just choosing one for them with them having no knowledge of the risks and other treatments available.
That's what I was getting at. If they don't want to know, then fair enough, but when possible, you're supposed to let the patient have all the information and decide what they want to do.

By refusing to know the diagnosis a patient may also be refusing further treatment. Of course you wouldn't treat without informed consent.

A patient may only want to know the basics of their condition or the likely prognosis or in fact nothing at all. Its up to the patient how much they know and thus where you go from there.

Reply 13

Original post by ForestCat

By refusing to know the diagnosis a patient may also be refusing further treatment. Of course you wouldn't treat without informed consent.

A patient may only want to know the basics of their condition or the likely prognosis or in fact nothing at all. Its up to the patient how much they know and thus where you go from there.

If a patient does want a treatment, but refuses to be told the risks, can you still treat them? Because it's not informed consent.
I get that you can't force the information on them, so what would you do then?

Reply 14

Ronove

Original post by Zebrajess

Erm I don't quite understand you.
Hearing their treatment options is surely better than you just choosing one for them with them having no knowledge of the risks and other treatments available.
That's what I was getting at. If they don't want to know, then fair enough, but when possible, you're supposed to let the patient have all the information and decide what they want to do.

I didn't suggest that you would treat them without them having given informed consent. Just that it's not a simple matter of:

1. Patient is ill with something that can be treated
2. Therefore I will break our agreement about keeping the patient in the dark

Such an agreement would be virtually worthless if that were the case.

Reply 15

ForestCat