How to Tell the Patient

There is no need to answer questions the patient has not yet asked. One way to approach the subject is to ask patients what they think the problem is, or how sick they think they really are. The response may be straightforward ("I think I have cancer"), or the patient may indicate a wish to avoid the issue by saying, "I hope it's nothing serious." The patient's condition can be revealed gradually or in stages, such as telling the patient after surgery that there is a suspicion of cancer, but that further information will have to wait for the pathology report. The physician should observe the patient's response to this initial suspicion and, based on that reaction, choose a method for presenting subsequent information. Tumulty (1973) supported the concept of gradualism in informing a patient and the family of the terminal nature of the illness: "The total truth is revealed in small doses as the illness unfolds, affording the family the opportunity to get its feet under itself before another blow falls____The patient and the family need to be eased into the truth... not slugged with it" (pp. 180-181).

Such a gradual disclosure is likely to lead to acceptance, whereas a harsh, sudden, or abrupt disclosure is likely to result in denial or severe depression. If the patient appears reluctant to accept the information, do not push the issue; merely make sure that openings for discussion are made available periodically and further information is provided when the patient is ready.

One statement is never appropriate: "There is nothing more that we can do." Such statements tell patients they are being abandoned and increase their feelings of isolation and vulnerability. There is always something the family physician can do to provide compassionate, comforting care to the patient and family, even if it is only sitting at the bedside so the patient does not feel abandoned. Distress can take many forms: physical, emotional, and spiritual, as well as anticipating symptoms that may arise, such as pain, constipation, anxiety, depression, and nausea. Family physicians also can help by stopping or avoiding treatments and diagnostic procedures that hold little promise of improving the patient's quality of life, such as taking vital signs or turning patients in bed when they are trying to sleep. If a test will not lead to a change in treatment, the test is not indicated.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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