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."