By Glenn Ellis
“The physician should be the minister of hope and comfort to the sick; that, by such cordials to the drooping spirit, he may smooth the bed of death, revive expiring life… The life of a sick person can be shortened not only by the acts, but also by the words or the manner of a physician.” The American Medical Association (AMA)
Most of us have recently heard the medical news about Congressman John Lewis and game show host Alex Trebek, who were both given diagnoses of Stage IV pancreatic cancer. This is not what anyone would call “good news”.
According to research from 2015, about 53 percent of people with pancreatic cancer receive a diagnosis when the cancer is in stage 4. Stage 4 pancreatic cancer has spread to other organs. This means that surgeons cannot remove it, and there is no cure. While the median survival rate is around three to six months after diagnosis, some people live longer than this.
According to the American Cancer Society, the five-year survival rate for people with stage 4 pancreatic cancer is approximately 1 percent. This means that one out of every 100 people with this type of cancer are still alive five years after their diagnosis.
Regardless of how each of these men fare in their respective treatment and outcome, this is definitely what some would call “bad news.”
For many of us, receiving “bad news”, the news alone isn’t the only worry. One of the reasons for this column is to address how not being to handle bad news in healthy way, can contribute to making our worst fears become reality. I’m speaking about the D word…depression.
The sense of hopelessness, and for some looking mortality (death) face-to-face, can lead to a depression filled with hopelessness, despair, and anxiety. All of these feeling can contribute to behaviors that cause a person to not want to “try” any longer; stop eating (or worst, don’t care what they eat); and even worse, self-destructive behaviors (drugs, smoking, alcohol). Needless to say, any, or all, of these behaviors can exacerbate what might otherwise be a beatable health challenge.
It’s almost inevitable that at some point you’ll have to deal with bad news or a scary diagnosis from a doctor. While it’s easy to read articles offering “tips for dealing with bad news,” when you get that news and you’re scared, all that advice can fly out of the brain pretty quickly. At some point in their careers, virtually all doctors and nurses face the duty of telling patients something they don’t want to hear.
A 2011 report from the Institute of Medicine emphasized that “effective pain management is a moral imperative, a professional responsibility, and a duty of people in the healing profession.” Nonetheless, few physicians are formally trained in effectively managing pain, and achieving this goal remains problematic. So, this can be a problem, if you’re expecting that getting bad news is an easy, and automatically smooth process.
This is not as easy as one might expect. In order to not be overwhelmed from receiving bad news, it can truly help to get as much information as possible from your doctor. Don’t settle for just being told, “We found something, and it doesn’t look good”. Ask questions and get complete answers to your questions. Often, we’re afraid, and learning as much as possible about our condition can help you come to terms with what’s happened and what the next steps should be. Just having a clear view of the facts can be calming in and of itself.
If you don’t understand something, when doctors don’t explain a diagnosis and next steps in terms you can understand, it can make an already stressful situation worse. Never be ashamed to tell your doctor, “I’m sorry, I don’t understand. Can you explain it to me in simpler language?” Keep asking questions until you do understand.
In many situations, the potential for getting bad news from the doctor happens when we go back for a follow-up, or to get the results of a test of some kind. If this is the case for you, it might be a good idea to bring someone with you to record important facts during the appointment. You may be unable to focus on the details because you’re distracted by impending news or your fears.
Having someone with you can make sure the information your doctor provides is clearly recorded for you to refer back later when you have more questions or find yourself unable to remember the answers you received during your appointment.
Most of us want to keep up strong appearances and be tough about the news. Being afraid is not the same as being weak. It’s brave to ask questions and battle your fears with knowledge.
Glenn Ellis, MPH, is Research Bioethics Fellow at Harvard Medical School and author of Which Doctor?, and Information is the Best Medicine. For more good health information visit: www.glennellis.com.