Saying it like it is or dashing a patient's hopes? Cancer patient told to prepare for death

[balo]

Why is liver cancer so common in Thailand , anyone knows ? 

[outsider]

2 hours ago, colinneil said:

Sorry i disagree with people getting upset when a doctor tells the truth.

Doctors were telling me and my wife 8 months to 1 year and you will be walking again.

My wife got angry with me when i told them BS, my spinal cord is broken and i know i will never walk again.

Only 1 doctor told the truth his words were....you can only look forward to a wheelchair nothing more, and i thanked him for being truthful, the others were telling me what they thought i wanted to hear.

 

+1... and then some!

 

(Sorry that you are wheelchair-bound).

 

[outsider]

No. Tell the patient she will live a long, happy and prosperous life. Might even pick up a few winning lottery tickets on the way too! And thank the doctor. Publish a story about how the doctor is such a life-saver and a miracle worker.

 

Then, when the patient bites the dust in two years, sue the lying bugger of a doctor.

[hotchilli]

2 hours ago, sweatalot said:

I have been working with a lot of dying humans - they all knew.

It is not simply telling the truth or lying - there is a third way: withholding the truth until it is requested, and there is a difference between offering a fatal truth - or force it on someone

Patients sometimes are not ready to hear the truth. And you don't know. Then it could be a good idea to start slowly, giving them a piece of truth that would make them ask for more or just the full truth. If they don't ask I'd leave it this way. May be next time they will be ready. I don't think it is a good idea to force the truth on someone who does not want to know. But always be ready to tell the truth when it is wanted. If you want to find out you could start with a question "what do you think how your ailment will go on?" 

At last someone who knows what they're talking about, every patient is different and must be treated as such. Treat the patient with respect, if they ask for truth then give it to them, gently.

Relatives are an entirely different kettle of fish !

[Bluespunk]

1 hour ago, Enoon said:

 

Everyone who contributes comment (and/or responds to it) on thaivisa.com is a netizen.

 

Do you really think all of them fit your description?

 

 

Netizens as far as I'm concerned are a special contingent of stupid.

[soalbundy]

2 hours ago, sweatalot said:

I have been working with a lot of dying humans - they all knew.

It is not simply telling the truth or lying - there is a third way: withholding the truth until it is requested, and there is a difference between offering a fatal truth - or force it on someone

Patients sometimes are not ready to hear the truth. And you don't know. Then it could be a good idea to start slowly, giving them a piece of truth that would make them ask for more or just the full truth. If they don't ask I'd leave it this way. May be next time they will be ready. I don't think it is a good idea to force the truth on someone who does not want to know. But always be ready to tell the truth when it is wanted. If you want to find out you could start with a question "what do you think how your ailment will go on?" 

I saw an American program on youtube about people dying in hospital. The woman doctor had a lot of experience. She had to speak with an elderly man who was terminally ill and was being visited by his wife. She started by asking about their plans for the future and from the answers it was clear that they both thought they could carry on as normal. When his wife said that they would be moving to their holiday home in California the doctor asked a simple question, "Have you made hospice arrangements in California"? Silence, then "erm no, is that needed"?  "I think it would be a good idea to think about the option, I can help you with picking the right hospice if you like and I will speak with your medical insurance". They took the news this way very well, as it was the man died a week later still in the hospital.

[ratcatcher]

23 minutes ago, balo said:

Why is liver cancer so common in Thailand , anyone knows ? 

There is a lot of alcohol of substandard quality consumed, especially lao khao upcountry. 

[wwest5829]

2 hours ago, bannork said:

In my experience the patient took the news bravely and stoically, Thais often seem to, I've met three who told me they had little time to live, 2 were suffering from liver cancer, and they were right.

I think the consultant had good intentions, it seems a previous doctor hadn't been straight with the family, still her manner of delivery was somewhat abrupt. She could have adopted a softer tone. Perhaps she was overworked and tired.

You are correct, there is such a thing as, “bedside manner”. Telling the facts as gently as one can ..... 

[Berkshire]

30 minutes ago, balo said:

Why is liver cancer so common in Thailand , anyone knows ? 

It's more prevalent in Isaan and is due to diet....

 

[For decades, certain populations in the north-east have been known to have abnormally high levels of liver cancer.

In men it comprises more than half of all cancer cases, compared to an average of less than 10% worldwide.

The high prevalence has long been linked to infection by liver flukes, a kind of parasite, found in raw fish.]

 

https://www.bbc.com/news/health-33095945

 

[overherebc]

32 minutes ago, balo said:

Why is liver cancer so common in Thailand , anyone knows ? 

Uncooked fish etc and ending up with liver flukes and that can lead to it or be helping its development has been suggested as a possible cause

[Captain_Bob]

Have watched many of my Thai wife's family and friends die, mostly from liver or stomach cancer, then a funeral party, monks chanting, procession, cremation. Thai's have a very different way of dealing with death compared to most western countries. I watched my wife tell her mother she was going to die soon from advanced stage terminal cancer and saw her go through the stages of panic, sadness, acceptance, and eventual peaceful departure with all the family at her side. Everyone dies - you/me/they have that time. Thais just don't sugar coat it much. 

[Cereal]

Doctor: "I've got good news and bad news. Which would you like first?"

 

Patient: "Give me the bad news doc."

 

Doctor: "You've got lung cancer from decades of smoking, 6 months to a year at most. I'm sorry."

 

Patient: "Dang....what's the good news?"

 

Doctor: "Packs of cigarettes are 2 for 1 at the canteen all week!"

 

Seriously though, I've had loved ones be diagnosed with terminal illnesses. They want it straight, not sugar-coated.

[alien365]

I must be getting soft in my old age as I had no interest in watching the video of a woman about to be told she will die. I'd prefer the honesty too, but damn that's got to hurt.

[blazes]

4 minutes ago, Captain_Bob said:

Have watched many of my Thai wife's family and friends die, mostly from liver or stomach cancer, then a funeral party, monks chanting, procession, cremation. Thai's have a very different way of dealing with death compared to most western countries. I watched my wife tell her mother she was going to die soon from advanced stage terminal cancer and saw her go through the stages of panic, sadness, acceptance, and eventual peaceful departure with all the family at her side. Everyone dies - you/me/they have that time. Thais just don't sugar coat it much. 

 

 

Yes, well put.  The thing is, every single person in the world (and on this thread!) is a dying human being.  As Shakespeare put it: "we are born astride the grave".

The problem is that, especially in the West, we somehow expect to be immortal.  Only the other guy, down the street, has to die.  And if some doctor tells me I have X months to live, I  will "battle" this horrible enemy called Death (Cancer whatever).

This notion of "battling" Death is what makes us miserable (and allows the pharmaceutical companies (not to mention the Naturopaths and all such quacks)  to make millions from our fear of Death.

 

 

 

[wombat]

20 hours ago, PJPom said:

All that I would want is pain relief if necessary,

as required.

[Joe Mcseismic]

1 hour ago, shady86 said:

This is the response when you use social security. They simply don't have enough budget to treat with universal healthcare budget.

An American?

A Republican?

[Shiver]

Remember also that the doctors can tell their truth, whilst at the same time being wrong.

 

I was told by no less than 4 independent doctors that I was screwed (huge cirrhosis of the liver "entering end stage" was the phrase of one of them) and that a transplant was the only option, which would be difficult to find.  One even said "you have 12 months, 15 at the outside".

 

I chose not to accept their truth, and after a very shaken and disturbed few days (I had to sign a waiver to be allowed on the plane home to Udon as I was so unsteady and so yellow and weak, which would be fine if I could actually write at that time), I got my act together and started 'google researching' (yeah the kind doctors don't like you to do).

 

My last scan was 2 months ago, and the results were same as the year before and the year before - It's fine, fully functional and no signs of any issues.

 

"Must have been a misdiagnosis" - yeah all 4 of them, each with their own ultrasound and bloodwork.

What I'm getting at is, if a doctor tells you you're gonna die in x weeks/months, and you believe them, then they're probably right.

If you choose to believe in yourself, then they might still turn out to be right, but cross that off your list of choices and don't give it any thought or energy - starve that thought, and get your mind to work towards your intentions.  You've got to dig deep and really believe in yourself, that you can do, or at least learn to do whatever it takes.

In my case I found a mushroom powder that was in Materia Medica but had little exposure to the alophatic world. Cost me all of $85 and faithful administration each morning in a small glass of water for the first 90 days, and after turning that corner it was a cake walk.  For people with different issues then of course the assist would likely be different.  Heck, if you're going to ground soon anyhow, why not have a good 'ole fight and die laughing?

 

[overherebc]

13 minutes ago, blazes said:

 

 

Yes, well put.  The thing is, every single person in the world (and on this thread!) is a dying human being.  As Shakespeare put it: "we are born astride the grave".

The problem is that, especially in the West, we somehow expect to be immortal.  Only the other guy, down the street, has to die.  And if some doctor tells me I have X months to live, I  will "battle" this horrible enemy called Death (Cancer whatever).

This notion of "battling" Death is what makes us miserable (and allows the pharmaceutical companies (not to mention the Naturopaths and all such quacks)  to make millions from our fear of Death.

 

 

 

Dylan Thomas.

 

Do not go gentle into that good night

Old age should burn and rave at close of day

Rage, rage against the dying of the light.

[peterb17]

I have lost so many to that truly horrendous disease - my brother- told OK you have 5 years - dead within 6 weeks after diagnosis. 

 

My dear Mum - she knew she was dying -came to stay for 2 months at the Dusit Thani resort in Pattaya , she used to have a  total blood transfusion in the UK - then set off travelling. The staff there were absolutely brilliant and looked after her very well. 

 

So - doctors need to be honest - I have no fear of death - I have had a wonderful life - so you need to be told . 

[Grandpa Cool]

Some years ago I was caring for my cancer ridden terminally ill Dad at home sharing the job with my Mum 34 hours round the clock. In his case he remained aware and lucid until his very last moment in time. He knew that he was terminally ill for many months. Slowly his body was disappearing  but still he was clinging on to a false hope that his time wasn't running out yet.

He was bedridden, absolutely no muscle tone, unable sit himself  up or turn himself over. Bed sores (pressure sores) from being static. We turned him over every 45 minutes or sat him up. It was the 1st week of November. I had just sat him up. He was literally just a bag of bones. He was 62 but looked 110!

He managed to raise his hands and patted himself on the skin and bones that were once his thighs and said to me "I'm doin' alright. I think I'll make it to Christmas." I replied "You're kidding yourself Dad."

He hung his head for a moment (from the shock of the ultimate realisation) then he thanked me for my honesty. The next week was such a wonderful time. We listened to music ,we laughed together, we cried together. Our conversations were real. There was no b.s.

Acceptance is a truly liberating emotion.

[sweatalot]

3 hours ago, SammyT said:

Absolute rubbish. It is the doctor's job to tell them what they need to know, not what they want to hear and then rely on them asking the right questions to get the right answer. 

It is not one sided, you know. The patient has the right to know, but he also has the right not to know. Their decision.

The doctor's duty is to respect the patient - and not force unwanted information on them. Not telling the truth does not mean lying - you just don't mention what they don't want to hear - always ready to give them all the information you have. And never forget - it is very difficult to tell how long - I have seen many survive much longer than expected and sometimes the opposite as well.

[DrTuner]

1 hour ago, balo said:

Why is liver cancer so common in Thailand , anyone knows ? 

Plaraa (flukes) and laukhao. Also assorted "healthy Thai food".

 

https://www.nytimes.com/2011/04/26/world/asia/26iht-thailand.html

 

Quote

“The government has never taken this seriously,” Dr. Cherdchai said. “This is a disease that affects only the north and the northeast, and these are regions that have been forgotten for a long time.”

Sod the peasants, as usual.

[Shadychris]

netizen
Dictionary result for netizen
/ˈnɛtɪzn/
nouninformal
noun: netizen; plural noun: netizens

    a user of the Internet, especially a habitual or keen one.

1 hour ago, Bluespunk said:

Netizens as far as I'm concerned are a special contingent of stupid.

Thanks for your self appraisal - for once I agree with you! With >20,000 posts in your 7 year membership on Thai Visa - an average of around 8 a day, I think it fair to say you're a 'habitual or keen' user of the internet...

[55Jay]

Only Doc I've had a "normal', pleasant experience with in Thailand so far is Dr. Nick.  And I don't mean only due to the ease of conversation in native English.  Both Thai Docs I've had the unfortunate experience of trying both left me gobsmacked for different reasons.

[laocowboy2]

I prefer the truth, although a little sugar-coating would not go awry. The following may be use to others.

 

I was correctly diagnosed with (Stage 1) colon cancer at Bumrungrad  back in April 2014 and had a successful operation to remove it. In August 2014 I went for a follow-up appointment with an oncologist at the Bumrungrad. After tests and scans I was told (and pretty bluntly) (a) that it had spread to my liver and (b) there was nothing they could do as it was inoperable. Prognosis 3-5 years to death.

 

Fortunately I had the means to go to the UK to the Royal Marsden for a second opinion. After a lot of tests and scans/MRIs over several months (repeat visits), the specialist liver/biliary duct surgeon said (a) he was pretty sure that the anomalies in the liver were NOT cancer and (b) that even if they did grow, he could remove them and the liver would re-grow. I have gone back for regular MRIs at the RM and now have (as if November last year) the all clear.

 

Am I angry at the misdiagnosis by the oncologist? No, it made me go to the UK to get that second opinion. I did however then realize that Thai doctors are apparently not trained in delivering bad news in a sensitive manner.

 

The original diagnosis followed occluded blood in a stool sample taken as part of an annual medical that I take at the Bumrungrad and a subsequent colonoscopy. There were no symptoms and without the check-up I would not have caught the cancer while it was still Stage 1.

 

Two take-aways from this. 1. Get an annual health check and 2. if the news is bad or requires a serious op, get a second opinion, preferably outside Thailand.

[Bluespunk]

11 minutes ago, Shadychris said:

netizen
Dictionary result for netizen
/ˈnɛtɪzn/
nouninformal
noun: netizen; plural noun: netizens

    a user of the Internet, especially a habitual or keen one.

Thanks for your self appraisal. With >20,000 posts in your 7 year membership on Thai Visa - an average of around 8 a day. I think it fair to say you're a 'habitual or keen' user of the internet...

Still doesn't make me a **** or as some call them, netizen...

[Catoni]

If it was me, I’d rather be told the facts....   everything is impermanent. Including this life.

[DrTuner]

5 minutes ago, laocowboy2 said:

I prefer the truth, although a little sugar-coating would not go awry. The following may be use to others.

 

I was correctly diagnosed with (Stage 1) colon cancer at Bumrungrad  back in April 2014 and had a successful operation to remove it. In August 2014 I went for a follow-up appointment with an oncologist at the Bumrungrad. After tests and scans I was told (and pretty bluntly) (a) that it had spread to my liver and (b) there was nothing they could do as it was inoperable. Prognosis 3-5 years to death.

 

Fortunately I had the means to go to the UK to the Royal Marsden for a second opinion. After a lot of tests and scans/MRIs over several months (repeat visits), the specialist liver/biliary duct surgeon said (a) he was pretty sure that the anomalies in the liver were NOT cancer and (b) that even if they did grow, he could remove them and the liver would re-grow. I have gone back for regular MRIs at the RM and now have (as if November last year) the all clear.

 

Am I angry at the misdiagnosis by the oncologist? No, it made me go to the UK to get that second opinion. I did however then realize that Thai doctors are apparently not trained in delivering bad news in a sensitive manner.

 

The original diagnosis followed occluded blood in a stool sample taken as part of an annual medical that I take at the Bumrungrad and a subsequent colonoscopy. There were no symptoms and without the check-up I would not have caught the cancer while it was still Stage 1.

 

Two take-aways from this. 1. Get an annual health check and 2. if the news is bad or requires a serious op, get a second opinion, preferably outside Thailand.

Ah right, reminds me when MIL had a scooter accident and injured the liver, the verdict from I think it was Pattaya Memorial that said she's gonna kick the bucket thanks to advanced liver cirrhosis (she barely drinks at all), Banglamung hospital young doc put her to bed and immediately recognized it as acute trauma. Been six years I think and she's bouncing around the kitchen happily right now. Won't go to memorial even if I accidentally cut both of my legs off, butchers.

[Ebumbu]

It's shameful that these so-called doctors don't even consider or suggest treatment with cannabis oil. The reason that Thailand is making it legal is specifically to treat cancer. So, the professors know. 

https://www.higherperspectives.com/there-are-now-100-scientific-studies-that-prove-cannabis-cures-cancer-1429984852.html

[marcusarelus]

I gave up drinking and smoking.  I'd want to know and have the doctor buy me a carton of cigarettes and a bottle of whiskey.