NEJM Audio Summary - Dec 15, 2011

Excerpted Script

21:22 | "Dealing with Uncertainty in a Time of Plenty", a perspective article by Ranjana Srivastava, from Monash Medical Centre, Melbourne, Victoria, Australia.
 It's the newest trend in medicine: “patient-centered care.” Cynically, the author thinks, “Isn't that what being a doctor has always been about?” But her curiosity brings her to a workshop, where two patients describe their experience of illness insightfully.  One patient has a 10-year history of prostate cancer, during which he's seen 12 experts.  “If you had told me at the start of my illness that more experts led to more confusion, I would have laughed. But now I get it. How can anyone reassure me about my health when they can't agree themselves?”  An audience member springs up.  An oncologist in his late 50s, he speaks with the kind of authority that can silence a room: “But your doctors don't agree because the data are not clear. It isn't their fault — do you understand that?”  “I understand that you can't make up an answer where there is none,” the patient responds, “but it's the way you say it that counts. I think you'd find that a lot of patients can deal with uncertainty, provided it's explained properly.”  ”But I can't give you reassurance if I'm not reassured myself!” protests the oncologist.  Troubled by the uncertainties in clinical practice, patients seek reassurance that doctors will work alongside them even in times of private doubt. How can we educate patients about what we know but avoid displaying hopelessness when we don't know?

寄稿者、Dr Ranjana Srivastavaのホームページによると、オーストラリアでOncologistをなさっているらしい。"tell me the truth"という患者との生死について語り合うことに関する著作があるようだが、アマゾンからは入手できないようだ。俯瞰記事自体は、告知の問題というよりはリスクコミュニケーションの問題なので、リスコミに関する岩田先生の本のリンクを貼っておいた。リスコミに関しては、少し古いが、US Environmental Protection Agencyによる"Seven Cardinal Rules of Risk Communication"にも要領よく纏まっている。