Doctors advocate openness

Medical professionals discuss doctor-patient communication.
Thursday, April 21, 2005 | 12:00 a.m. CDT; updated 2:07 a.m. CDT, Wednesday, July 2, 2008

David Fleming asked the crowd a tough question.

“How many of you would want to know if you had a terminal illness?” he said.

Almost every health professional and student in the room raised his or her hand.

“How many would not want their families to know?” said Fleming, a doctor and MU professor of clinical medicine. Only a few raised their hands.

More than 50 medical students and professionals gathered Wednesday at MU’s School of Medicine to discuss Fleming’s rhetorical question and other end-of-life ethical issues as part of a nationwide dialogue.

The 12th annual National Bereavement Teleconference addressed problems and methods in informing patients of terminal illnesses and ongoing support for families and patients after they have been discharged from the hospital. The School of Medicine’s Center for Health Ethics sponsored the local part of the event.

Medical professionals at the conference agreed that issues of patient rights versus patient benefits are not always black and white. They said that open doctor-patient communication is crucial in preventing problems.

“Ethical dilemmas occur because of miscommunication,” said Richard Fife, a panelist who spoke to the MU audience from Washington, D.C.

Fleming, director of Center for Health Ethics, said he thinks more information is better than less.

“I have come to the conclusion that it’s always best to give as much information as the patient needs and wants,” he said. “Ninety percent of patients want to know.”

He said doctors have to be cautious of how they break the news.

“It’s not the information, it’s how we tell them,” he said.

Panelist Joanne Reifsnyder, a University of Pennsylvania nursing professor, said that the patient-doctor relationship is also important.

“Truth telling needs to occur in the context of a relationship,” she said.

Panelists cited the Terry Schiavo case to stress the importance of having advance directives.

“This is a hot topic right now,” said Fleming.

The assembled experts said it’s important for people to let their families know what their wishes are, even before they become ill. Fleming said in his experience, about one in five patients have advance directives, including people with serious, chronic illnesses.

But even with advance directives, doctors sometimes have to go against a patient’s stated wishes because they fear legal recourse, panelists said.

Following the national broadcast, a panel of local health professionals discussed problems and methods used in topics ranging from breaking information to patients to the removal of feeding tubes.

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