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¶ … population ages, it will become increasingly important to know how to care for the chronically ill and dying elderly patients. An article in American Family Physician details one of the problems that arises in such cases: denial. The article tells about an incident where a man who is in constant pain repeatedly goes to the doctor, but will not accept that his symptoms could be caused by cancer. When the doctor offers to make a referral to hospice for extra help, the patient adamantly refuses the care. At first the physician does not give up his potential persuasions, which include stressing the patient's personal responsibility concerning the need for loved ones to see him free of pain. Yet the same scenario continues until, unfortunately, the man dies.
The author of the article, Dr. Karen Ogle, explains that denial is a common coping mechanism in the terminally ill. People rely on denial in different...
This denial may also vary widely on a day-to-day, or even a minute-to-minute basis. In this case, the denial is very strong and irreversible.
Dr. Ogle adds that although the doctor said he tried his best to persuade the man to get additional care, perhaps more could have been done. By coming back to the doctor's office time and time again, he may have been approachable by establishing "an alliance around the pain" and building slowly to a mutual understanding of the current situation: "You have been having a lot of pain . . . We have done a number of tests . . . The results show that . . . This means that . . ."
One of the ways to break bad news, she adds, is to retain respect patient's personal choices about coping, while expressing concerns in a balanced and clear manner: "I know…
Unforunately, notes Ogle, there will always be those idividuals who never want to accept the truth and remain in denial until they die, like this above-noted patient,. This is even when such people realize the negative effect this is having on their spouse, children and other family members and friends.
This is not wrong or bad. Everyone has his or her own way of "dying well." How a person is acting has a reason, even if it is unknown to the observer. However, in some instances, the most beneficial support the healthcare profession can offer is just to join with the patient and his or her family in the manner elected but not understood by outsiders. This often means to leave behind the usual "toolbox" of medical responses and instead rely on the basic goodness of humankind. As she concludes: "Caring for the dying is remarkably challenging work. It can also be remarkably rewarding. If we meet the deeper challenges requiring our presence as human beings, this work can be among the greatest privileges of being a physician."
Ogle, Karen. "Approaching a terminally ill patient in denial." American Family Physician, October 1999. [electronic version].
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