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Full Disclosure

August 12, 2011

full disclosure n. the need in business transactions to tell the “whole truth” about any matter which the other party should know in deciding to buy or contract. In real estate sales in many states there is a full disclosure form which must be filled out and signed under penalty of perjury for knowingly falsifying or concealing any significant fact. (See: caveat emptor)

In the medical perspective, this includes disclosing harmful medical errors to patients.

A gap exists between recommendations to disclose errors to patients and current practice. This gap may reflect important, yet unanswered questions about implementing disclosure principles.
Case 1: Don’t Ask Don’t Tell Dilemma (even if the patient don’t ask doctors should tell)
Case 2: What You Don’t know Won’t Hurt you (wrong!)
Case 3: Shades of Gray (then make an effort to explain why its neither black nor white!or how you came to make the known -KNOWN and what efforts you have exerted to know the UNKNOWN and whilst there are UNKNOWNS what is it that we can do to manage what we already know)
Read more here

In an ideal world, when one is diagnosed with cancer, the patient can ask the oncologist to provide full disclosure. But in reality, a terrified patient cannot even ask these questions on the onset, because they have to deal with the gamut of emotions that comes with a diagnosis. This is the reason why it is important for a cancer patient to have an ADVOCATE. An advocate is anyone who loves the patient unconditionally and will try to detach herself/himself emotionally and will be able to ask questions with objectivity, tact and firmness (I tried my best, believe me)..

Ideally, if I could have turn back time, these are the questions I would have asked the surgeon, the oncologist and radiologist who saw my mother last year.

Now if we know that just being exposed to these chemicals causes cancer, how much more damage and sickness is being given to the patient who is taking these substances internally? That is the real question that deserves a lot of contemplation. In fact, I think that there are a number of questions that need to be answered before one decides to embark on chemotherapy treatments:

•Is it really possible that chemicals that are essentially chemical warfare weapons can give a patient long-term health?
•Can a highly carcinogenic substance be a cure for cancer?
•Should you trust a physician that is highly paid to give you chemical warfare weapons for medicine?
•Is your oncologist under pressure to provide you with certain medications and substances, or is he free to explore any treatment options that he may uncover if he decides to investigate them?
•Is it legal for an oncologist to use any other cancer treatments besides chemotherapy, radiation and surgery?
•How truly effective is chemotherapy at treating cancer, and where are the supporting studies?
•What reliable studies demonstrate that chemotherapy is more effective than any other cancer treatment?
•What are the real rates of side effects that are experienced by patients who receive chemotherapy?
•How much does your oncologist pay for your chemotherapy, and how much does he charge you for prescribing it?
•How many cancer patients are alive after 10 years of the initiation of chemotherapy, and if alive, what is their health condition?
I think that the above questions are fair questions to ask, and that they deserve honest answers. After all, isn’t full disclosure in the best interest of the patient?
Read more here

The likelihood that most medical practitioners know that full disclosure is the “right thing to do” is high, but the likelihood that they also do not have the moral courage to do what needs to be done is also quite high.

Knowing the “right thing to do” does not normally mean that person is going to do what he ought to do. There are dilemmas that they have to face with such as spending more time to deal with anger, remorse and even possibly panick attacks. Some doctors usually base their professional fees on the amount of time they spend with each patient (just like how a taxi meter works). Nevertheless, most doctors would not risk spending those extra hours for extra dollars, as it makes them exceedingly uncomfortable.

As an advocate, I also had assumpions to overcome about asking questions “e.g. the doctors are experts they know better, or if I ask questions, I might put myself into a bad light and therefore receive bad treatment”. Granted that I had to learn to be assertive as an advocate, I guess the medical practitioners are on a higher ground to explain even the things that I don’t ask (because honestly most of us DO NOT KNOW WHAT WE DONT KNOW- so how can we ask?). Sometimes, ignorance is bliss but when a love one is facing cancer, this is a state of bliss that you would regret later on.

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