Tell,the,truth,doctor,Tell,the health Tell me the truth, doctor!

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=================================================================" Tell me the truth, doc!"=================================================================Would you call that a honest demand?I wouldn't.In ordinary circumstances, a patient would never ask thatfrom her doctor (yes, let's assume we talk about a 'she'patient).She trusts him -- let's also assume her doctor is a 'he one'--and she knows that he always talked genuinely with her.And never would hide anything important concerning herhealth condition.Really never?It CAN happen that the doctor, quite unsure about a possiblebad evolution in his patient's condition, prefers to keep quiet.But when the patient's condition has obviously been worsening,she guesses very often that her doctor is trying to hide her hisopinion about her situation.And then, sometimes, she finds the courage to ask him, in factto beg him:"Tell me the truth, doc!"What does she really mean? Most probably this:"Stop, please, hiding me what you really think about thepossible evolution of my illness!"And such a demand is a very serious one when the doctoris actually concerned with the possible nearby death of hispatient!What can he tell her without risking to loose or -- at least -seriously damage her trust in his sincerity?Should he talk her about the statistical probability of herSurvival? I don't think it would be a wise answer.The Medical Faculty taught him that an average patient atthis stage of the evolution of this special illness will probablybe dead before so many weeks, months or years.Probably the "average" patient, yes. But is SHE one of theseaverage patients the stats tell us about?Okay, MOST patients will behave according to the stats.Let's say 90%.But the remaining 10 %? What will THEY do?Let's assume that 5% will die earlier, maybe much earlier.But the 5% -- at the other extreme of the probability curve -will live much longer. Maybe not die at all (at least fromthis disease.)One talks then often of a medical miracle. But it's nothingmore than a totally foreseeable statistical phenomenon: theexception that "confirms the rule".Not SO exceptional either: one on the hundred 'members' of theStats may expect such a good fortune!Why not her? This very patient of mine, there in front of me.I really don't know for sure how this life endangering illnesswill develop in HER case. I can just make suppositions -- forand in myself.Nothing I can tell her, of course. But I owe her an answer!A quick college statistical, nevertheless? Maybe. But notevery patient can be satisfied with such an vague answer.She wants to know HOW SHE will DO in the nearby future.She doesn't care about ONE'S ILLNESS where the scientistsalways talk about.I could talk her - I did that several times during my career as afamily doctor -- about the really life endangering present stageof her illness. That she possibly could die, not so far away.BUT that her WILL to fight for her life, even in this dangerousmoment, can make that SHE won't die, that she will make truethe next medical miracle in my career!And that I am eager to help her realize that miracle.That remembers me of a patient of mine, a sixty six old man bywhom a quickly developing colon cancer had been diagnosed.When he asked me how long the Faculty gave him to survivehis operation, I honestly answered him: "Probably half a year"and encouraged him to fight with all his power.He fought successful one and a half year, with the help of someexpensive but very efficient holistic drugs. A month before hecollapsed, he spent a beautiful summer holiday with his familyin the Austrian Alps. He was even able to make some climbing.When he realized that all at once his strength was fleeing away,he asked me once more how long I thought he might stay in life.My answer was; "A couple of days if you stop feed yourself."He chose to stop even drinking, but asked for opiates to lessenthe pain and died very serenely a week later, short after a nicefarewell ceremony from his family which he asked the parishpriest to organize around his bed.This is of course the way many of us would prefer to die. Noteverybody however wants to stay as conscious till the utter end.Not every patient can stand the naked scientific "truth" abouther nearby death. Many less courageous people will receivefrom their doctor a different version of the truth they maintainto claim.The duty of the 'accompanying' doctor is to evaluate and toreveal to each patient the amount of "truth" she is able to copewith. Not more but certainly not less.Each patient is a unique person who deserves an appropriateand even unique answer to her solemn request. Only a soundknowledge of her psychological - and spiritual - needs caninspire the right words to her 'end of journey' counsellor.If you let me give you a good advice, dear reader of this mail,Don't wait till the fore last minute. Choose in time the doctorwhom you will be able to ask -- in full trust that he won't lieor hurt you --Tell me the truth, doc!=============================================I hope you won't mind if I make now a few 'philosophical' orlinguistic' reflections.You know, I taught medical psychology for 20 years to a lot ofmedicine students. In fact since the very beginning of theAntwerp Medical Faculty.And all those years I tried to make my teaching languageeach time clearer and more adequate to the topics I discussedwith my 21 years old students.They were not more than 30 in the heroic beginning of theUniversity : almost boys. But in my last years, they wereAlready more than 100 -- almost girls. Times do change.I am sure you'll forgive me to have revealed something aboutmy own person before you take the challenge to follow me inmy more "philosophical" reflections.If you are NOT so interested in such a "heavy" topics,please * J U M P * straight to the END of next section:==============================================BUT.if you ARE, Fellow Heavy Thinkers, here we go!============================================== 4. The Editor's view about Truth!=============================================What for a "truth" is the patient here above asking for?What would SHE call The Truth in this case?A plausible description of the development of her bad healthcondition. An explanation she can believe and put up with.But a "truth" her doctor also really can believe. And actuallydoes believe. In fact she asks for a "truth" they both believein and want to work with.Is The Truth then nothing else than a suitable, from bothpartners agreed tale? A story we now believe becausewe trust each other TODAY ? Maybe we won't believe"that truth" tomorrow any more. But another truth:Our tomorrow's truth.Truth - our truth - is like a living being: it has to be born,To live a certain amount of time, to die and fully disappear.Just as our Feelings do. Their existence is limited to theduration of our actual relationship to a person or an object.Do I assume then that there is no other Truth than such one?Yes, I do. Truth is for me "social stuff". A kind of secretbetween a "You" and a "Me".And a secret "we" BOTH believe in.For the present moment.And this "You" has not to be a person of flesh and blood.It can be God, the Bible, or even the Science, the Fate.As long as I confirm "Your" existence for me by talkingto "You", by BELIEVING in "You".Truth is thus a question of belief, of trust.When the trust is over, the belief vanished? "Farewell Truth!"Scientific Truth becomes "a remnant of a primitive stage ofMankind". Do you remember the "childish" conception ofthe old Ptolemy: the Earth as the centre of the Universe?Even Religion is often degraded nowadays to the status of anice fairy tale "we" once believed when "we" were just kids.And consider how difficult it is for us to remember vividlythat we have really been in love with a person we now fearor despise so much.But we really have been, you know! And it was true love.THEN.Let me try to give an exacter definition of the word truth,as we commonly use and understand it:Truth is what both (or more) partners agree to be trueat the very moment of their trustful conversation.They both (or all) believe that truth. But They arethe only ones to can bear witness to it.Nobody else can.Truth has nothing to do, consequently, with a PermanentUniversal Reality that would exist on its own, either webelieve it or not.Truth has thus nothing to do with Objectivity. With Facts.And only facts seem to obey to the laws of the contemporaryScience. They can (mostly) be checked by an independentobserver. One can measure them, mathematically analyse,repeat and predict them.Do you need to believe something or someone to be sure abouta fact? NO ! You just have to check it by yourself.Facts can't be true or false. They just ARE there, outsideof us, 'waiting' till the Science begins to explain them. Inother words, till we perceive them and give them a name,a significance.And that name IS NOT the fact itself , but the OPINION onehas about this fact (e.g. "the Earth is flat") depending a lotof the explanation the Science builds around that opinion.Many scientific theories and axioms have taken, nowadays, theplace of the former religious Authority. You have to agreewith them if you want to build a career at the University orif you want to be published in a "serious" magazine.Just as the Churches did in the old days, the 'Academics' teachthe people what they SHOULD now believe about the universe, ifthey want to avoid a conflict with the 'spiritual' Authority.Those scientific dogmas (or paradigms, as they were recentlyrenamed), are presented to the people as the Truth. And theyARE really the Truth . for those who BELIEVE in them.As long, of course, as the present believers won't loose their'faith' in them. And choose a new scientific Truth to believein (also doomed -- of course -- to disappear sooner or later.).This has always been and will probably ever be the behaviourof the upper intellectual class.Why do I insist so heavily upon this point?Because the Holistic approach of the reality (and of courseof the Medicine) proceeds from an other paradigm (anotherbelief about what is real) than the paradigm of the majorityof the contemporary scientists.But I'm sure it has been enough for today. We'll surely talkagain about that big problem. In one of next issues.