A study published recently in the PMJ<\/a>\u00a0<\/span><\/strong>from Dr Jeba and colleagues in Tamil Nadu looked at the prevalence of collusion during consultations with patients being seen in their palliative care clinic. \u00a0The authors defined collusion as consultations where information was withheld from the patient primarily at the request of family members. \u00a0There was surprising number of patients who made it to the palliative care clinic without knowing their diagnosis at all (18%), and collusion regarding diagnosis or prognosis was present in 40% of cases referred. \u00a0Of these, within a month 58% had had this collusion addressed. \u00a0The remaining cases were thought to be those where the family request for information to be withheld was very strong and persistent.<\/p>\nThe study looked at factors which might be associated with collusion and found that\u00a0collusion was more prevalent where female patients were affected, and was more prevalent amongst patients whose occupation involved manual labour. \u00a0It was felt that cultural norms will have led to a bias against women being fully involved in decision making. \u00a0Manual labour may have been a surrogate for educational attainment – and it is well described that less educated patients often have less information needs.<\/p>\n
Fascinatingly, the study also revealed that if the family member attending the clinic was the spouse of the patient, collusion was very much less likely. \u00a0Perhaps the presence of one who knows the other so well simply means there are less opportunities to hide feelings and knowledge. \u00a0Other than trying to ensure that the spouse was present when a diagnosis was being discussed, no firm conclusions were made.<\/p>\n
These three scenarios – doctors chasing an illusion of wellbeing – patients believing in a treatment will do what it emphatically cannot \u00a0– and finally collusion between treating doctors and relatives – are all important reminders that doctors hold a vital position of power, and how we wield this power has a significant impact on the patients we consult with, treat and comfort.<\/p>\n
The delusions, illusions and collusions we all engage in as physicians are well-intentioned, but as the internet democratises information, and patients are no longer so willing to be advised directly on a course of action or of treatment – doctors must change.<\/p>\n
We must truly reflect on our interactions with patients – and work out if we are peddling a myth, and if we are, why? Is it our own biases, experiences or fears? \u00a0And if we are acting in the best interests of the patients – have we actually given them an opportunity to express their opinion?<\/p>\n
I suspect that if we do each of these things – we might find that the ones who have been a little deluded – chasing an illusion – are ourselves.<\/p>\n","protected":false},"excerpt":{"rendered":"
Fending Off Death 1 by wiebkefesch on DeviantArt Doctors are – in the main – trained to prevent death. \u00a0Modern medicine has made huge advances, and life expectancies continue to rise. \u00a0However, there remains only one certainty in this life – that we are all going to die. Patients in the last year of life […]<\/p>\n
Read More…<\/a><\/p>\n","protected":false},"author":200,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[1],"tags":[6558,21,17,1406,6560,7,881,6559,6557,18,19,23],"class_list":["post-162","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-collusion","tag-communication","tag-consultation","tag-death","tag-delusion","tag-education","tag-illness","tag-illusion","tag-palliation","tag-patient-centred","tag-patient-experience","tag-self-efficacy"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p4xocP-2C","_links":{"self":[{"href":"http:\/\/stg-blogs.bmj.com\/pmj\/wp-json\/wp\/v2\/posts\/162","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/stg-blogs.bmj.com\/pmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/stg-blogs.bmj.com\/pmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/pmj\/wp-json\/wp\/v2\/users\/200"}],"replies":[{"embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/pmj\/wp-json\/wp\/v2\/comments?post=162"}],"version-history":[{"count":0,"href":"http:\/\/stg-blogs.bmj.com\/pmj\/wp-json\/wp\/v2\/posts\/162\/revisions"}],"wp:attachment":[{"href":"http:\/\/stg-blogs.bmj.com\/pmj\/wp-json\/wp\/v2\/media?parent=162"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/pmj\/wp-json\/wp\/v2\/categories?post=162"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/pmj\/wp-json\/wp\/v2\/tags?post=162"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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