A few years ago I heard a story from a nurse in an eastern European hospital. She was looking after a patient who had cancer. The diagnosis was quite clear but the senior doctor had decided that the patient should not be told. Quite the contrary he was to be told that there was nothing serious wrong with him. All the staff, including the medical students, were instructed that under no circumstances was the patient to be told the truth. This turned out to be too much for most of them.
They could not face the patient they had lied to, so they avoided him. He died isolated from human contact during the last weeks of his life.
The reason for this deception? Apparently it was that ‘Giving the diagnosis might cause him to give up hope.’
What hope?
I suspect that, like many patients with advanced cancer, he knew perfectly well what was wrong with him. In the end he died without hope because there was no one there to give it to him. Indeed, there was nobody there to give him even the most simple human comfort.
Hopelessness is a serious condition, reaching epidemic proportions, particularly amongst the young of Europe. Not only is it a risk factor for suicide independent of depression, it is also a predictor of future heart disease and cancer. In a prospective study of 2428 otherwise healthy Finnish men aged 42 to 60, those with high levels of hopelessness experienced a fourfold increase in new heart attacks over the next six years. They also experienced more than twice the incidence of new cancers compared to men with low levels of expressed hopelessness. (Everson SA et al Psychosomatic medicine 1996; 58:113-121).
How much did hopelessness contribute to our patients’ cancer? We will never know. How much does hopelessness contribute to the burden of cancers and heart attacks in your country? We don't yet know.
But one thing is certain, your patients will look to you for hope and comfort in their confusion and distress. Will you be able to give it?
Never forget - you cannot give what you do not have.
Dr David Chaput de Saintonge
PRIME Education Director
On behalf of PRIME – Partnerships in International Medical Education
www.prime-international.org.uk
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