by Olivia Bredbenner

Created on: October 25, 2009

The relationship between a doctor and patient is confidential and protected under the " Privacy Act." During an illness , a long standing relationship between a doctor and a patient has formed , there may have been many highs and lows in the treatment of their illness before they have reached the terminal stage . The doctor may have over time also developed a relationship with the patient's family, as the patient and family are considered a unit under most circumstances.

On observing doctors and their patients as they interact through out a patient's illness. You would see the intricate path that is taken by a patient and their doctor who feels that they are losing their battle over the illness. The doctor must now deal with the true course of a disease.

Most often, there is a quiet acknowledgement between the patient and doctor when the end of life is near. Open communication, sometimes without saying out loud "You are terminally ill" takes place. When the doctor at an earlier point may have suggested to the patient that they should get their affairs in order. Confirming with the patient at that time, ,that the physician has not given up the pursuit of care and treatment, but that options are running out.

The family may or may not be open to discussing this around the patient. Even if the doctor has told the family the "same "clinical information on the patient's status. There is often fear that the family express' to the doctor ,that if their family member knew of how seriously ill they were. They would not be able to handle this news and give up. Some families in trying to protect their loved one. Then asks the doctor not to tell the patient how ill they are.

There can be times when a doctor patient relationship is " A compensatory alliance. " When a patient may be seeking an "alliance" with a doctor which "compensates"for conflict or deficit in the family system. Therefore, it is essential that the doctor perform an early assessment of family dynamics. If there are signs of dysfunction within a family or the patient has eluded to an existence of such, it may make it difficult to care for the patient .."The doctor must then be keenly aware and manage the "compensatory alliance" in a productive and therapeutic fashion."

In the real world of medicine communication between patients and caregivers is often a fine art. When open ended questions are used and the reality sets in, it is the patient who really knows the truth. Doctors and nurses are often privy to personal conversations where the patients express' how much they love their family and the concerns common to all of us at the end of life.

The patient has intricately captured the doctor's commitment to their care with the expectation of confidentiality, and both, acknowledge to each other their understanding of the terminal course that their illness is taking Not saying " it " out loud does not make it less true. When a family asks a doctor "not to tell the patient" It may allow time and give comfort to a family who needs to come to terms with their loved one's illness. However, in truth it is the patient that often tells the physician. Then knowing waits for the confirmation.

http://linkinghub.elsevier.com/retrieve/pii/S0953620 506001312

http://www.annals.org/cgi/content/abstract/109/11/88 4

http://www.aafp.org/online/en/home/policy/policies/c /confidentialitypatientphysician.html

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