What Ruth’s doctor had done was unusual, or maybe even inappropriate, they told me — delivering bad news, especially over the phone, before it needed to be conveyed. When I asked them when the right time was to tell someone that death is unavoidable, they most often told me that the moment occurs after several successive attempts at stopping the cancer have failed. Only then, when the patient is cornered by cancer, that’s the time.

Doctors claim that patients aren’t ready for the bad news earlier, when they are still digesting their shocking predicament: that their lives have changed irretrievably; that their priorities, their future aspirations, their promises to their loved ones-both the explicit and, more important, the implicit ones-would go unfulfilled. They cite their own hesitations too. Doctors want to be purveyors of hope rather than despair, a motive sometimes attributed to compassion, sometimes to a starker concern that patients will find a new, more optimistic second opinion.

I’m a fan of bluntness, but I know it can be detrimental when a patient isn’t ready and can cause confusion when other doctors are shimmering with lighter scenarios. Ruth’s doctor may have done the right thing despite what my friends were telling me. There’s a famous report from the Institute of Medicine showing that nearly all adults say they want doctors to share what they know, even if the news is bad. Ruth had expressed this sentiment to me many times, as in “I don’t want my doctor knowing something about me that I don’t.” (Examiner) >

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