by Connie Jorsvik
Statements of false reassurance and hope that patients hear all of the time from doctors and nurses but the only person they reassure is themselves. These statements damage the health provider-patient relationship and have the potential of causing physical and emotional harm – and possibly death.
To our nurses and doctors, we ask that you tell us the truth. Please never again say:
- “Don’t worry.”
- “This is a minor problem – nothing to worry yourself over.”
- “You’re just being overly anxious about this.”
- “You’re being hyper vigilant.”
- “I would tell you if there was something to worry about.”
- “It’s a minor problem that will resolve itself.”
If you are concerned about any health issue, you have every right to be concerned, and any of these statements should be a big red flag that you are not being heard or being cared for appropriately.
As a cardiac nurse I heard statements like this dozens of times: “My doctor said there was nothing to worry about so I shrugged off this round of chest pain until my wife (husband, daughter…) called 911. I guess it was a bit more serious than my doctor thought.” I often wonder how many patients didn’t make it to hospital after their doctors had given them false reassurance and had told them, “Don’t worry, it’s probably indigestion. Go home and take it easy. I’d tell you if there was something to worry about.”
What every one of those doctors could have and should have said was something like, “You know what Mary? I’m hoping for your sake what you’re experiencing is just indigestion. But to be on the safe side, I’m going to send you for some lab work and an ECG. In the meantime, if the chest pain is worse, I want you to call 911 and get into the hospital and they can sort out what it is – that’s what they’re there for. And, when it turns out it was that old ulcer of yours just acting up, we can have a good laugh about it.”
Truthful reassurance of a patient can lead to increased trust and compliance and can for experienced as an empathetic response of a concerned physician. False reassurance, however, is essentially lying to a patient and can badly impair the patients trust and compliance. False reassurance is often given form a despite to make a patient feel better, but once a patient knows that a doctor has not told the truth, the patient is unlikely to accept or believe truthful reassurance. The Patient Doctor Relationship: Synopsis of Psychiatry (10th Edition)
Karen* has been given false reassurance all of her adult life for a constellation of symptoms that have become debilitating and potentially life-threatening. Finally, after more than six months of referrals and hard questions, we’re finally getting somewhere with a possible diagnosis but the psychological damage has been done: she doesn’t believe a single doctor we talk to. Until there are hard and undisputable facts on paper she will continue to believe that all doctors are lying to her.
Jill* is the model for the empowered patient. She asks for the truth and despite that, she is given false reassurance every day from her nurses about an infection that won’t heal and keeps on getting re-infected. When a new area of infection rears its ugly little head, she has been told on numerous occasions that, “Everything is healing and is on course,” when it’s readily apparent that everything is not on course.
Here’s a little script they could use that provides the truth, laced with some honest hope: “I’ve seen wounds that are a little stubborn to heal like yours and it usually just takes a little extra time and diligence. But I’m seeing a little spot here that needs to be watched. I’m going to take a swab and then we’ll both feel better about it. Neither one of us wants to see another positive culture but it’s better to
Studies have shown that patients with cancer
When I was a student nurse I was assigned a patient with end-stage COPD. Her only position of rest was to sit with her arms and head draped over pillows on a table; every breath was labored as she essentially took in as much air as a healthy person would sucking through a straw. I sat at her bedside and asked what I could do for her. She said, “Would you please tell me if I’m dying? No one here will tell me the truth. I need to let my family know and put things in order.” As gently as I could, I told her she probably was dying – maybe not right away, but the disease would take her life. She thanked me for my honesty.
The next day I was called in to talk to the head nurse. The incident had been reported to her and she chastised me for taking the woman’s “hope”. Looking back on it, it was not my position as a student nurse to be giving her the information, but I have never regretted it. The patient died a few days later with her family by her side – and if I hadn’t told her, I think she probably would have died alone.
It turns out, most people want the truth. We want the hard facts so we can deal with what is ahead of us, whether it’s that a simple procedure will cause some minor pain, to the possibility of surgery that will change our lives, or that we are likely to die. We’ve made decisions for ourselves all of our lives and it is not up to our doctors and nurses to make a decision of what we can handle and what we can’t. It is their job to give us the information (with care and compassion) and then do what we will with it and make the decisions we need to make.
In his extremely popular TED Talk, Matthew O’Reilly, a critical incident paramedic (EMT) describes his revelations in his talk, “Am I dying? An honest answer.”
I was afraid that if I told them the truth that they would die in terror, in fear, grasping for those last moments of life. Five years ago, I responded to a motorcycle accident where the driver had sustained critical injuries. As I assessed him, I realized that nothing that could be done for him. He looked me in the eye and asked the question, Am I going to die? In that moment, I decided to do something different. I decided to tell him the truth: that he was going to die and there was nothing I could do for him. His reaction shocked me to this day. He simply laid back and had a look of acceptance on his face… As he lay there, I saw inner peace and acceptance. From that moment forward, I decided it was not my place to comfort the dying with my lies.
Sometimes, I want to tell me clients that everything will be alright – and every once in a while I catch myself falsely reassuring them (for my sake, not theirs). Sometimes my clients want me to lie, even when they know the truth… “Just tell me it’s going to be alright!”
Gandhi said, “Be the change you wish to see in the world.” In this case, I want to give the truth, with empathy and compassion, to my clients. In turn, I hope that it is an idea that takes hold within the medical professions because it is not our place to comfort our patients and clients with lies.