OWINGS MILLS, Md--"I once worked with an oncologist who would
not treat a child the same age as his son. One year it was 10;
the next year, 11," said Daniel Timmel, LCSW, of the Medical
and Chirurgical Faculty of Maryland (the state medical society).
"Defenses are very interesting."
Speaking at a symposium on palliative medicine sponsored by the
University of Maryland Cancer Center and the NCI, Mr. Timmel addressed
the question of what terminally ill patients and their families
say they want from their physicians. His bottom-line answer: honesty,
presence, and leadership.
The physician may fail to fulfill these patient desires when his
behavior is driven by subconscious defense mechanisms against
such things as death, anger, and his own sense of mortality, rather
than by professional knowledge, he said.
Self-defenses can interfere with professional care by causing
a physician to avoid a dying person (denying the patient and family
the physician's presence and leadership) or to be less than honest
about the prognosis, Mr. Timmel said.
There are powerful reasons for defense mechanisms, he noted. The
key is to recognize them and "tell the difference between
our need and the patient's need."
Honesty: The Best Policy
Patients and their families look to physicians to lay out what
they can expect. "They haven't been there, and they need
some guidance," Mr. Timmel said. "We often don't know
what's going to happen ultimately, but we usually have a good
idea of what is going to happen next. Make sure you don't promise
something you can't deliver."