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‘Ignorance can be bliss: be mindful with your patients’


We often assume that patients want to know everything about their condition, but we should challenge this assumption and think twice before imparting too much daunting knowledge to them, says Ian Dove

I sometimes hate the reality of knowing too much. As a nurse of 10 years recently diagnosed with arrhythmogenic right ventricular cardiomyopathy, there are some details I wish I didn’t know. Sudden arrhythmias, some of which are life-threatening, are par for the course with this condition.

Knowing that only 8.6% of people having out-of-hospital cardiac arrests survive and that no prevention strategies are available isn’t comforting. If you survive that, you can welcome the gradual slide into right-sided heart failure which could lead to breathing problems and eventually the need for home oxygen.

Pessimism aside, all of these facts bounce around in my head when considering my future or a large ectopic thuds in my chest – maybe my body reminding me not to get carried away.

This diagnosis has given me a new understanding of those patients who do not want to know the facts, figures and life expectancy. The ones we frown about after they leave, assuming they haven’t accepted their condition or are in denial. The reality is they may well have fully accepted their fate, but are not concerned with knowing the gory details, they just want to know how to move forward.

I appreciate both sides of the coin and have been guilty of judging people’s health challenges in the past. What I’m asking you to consider for your patients is “do they really need/want to know this? Will it improve their life?”

Health promotion and education is usually focused on informing the patient as much as they will allow. Is this blanket approach to information ideal?

We talk about individualised care in the NHS, yet we still have certain generic practices. If these assumptions go unchallenged, they could have a negative impact.

My own experience is different, as my medical knowledge came before diagnosis. As a research-based practitioner, I also did some of my own reading around, only to find out there is very little to be done about preventing deterioration in future. You cannot unlearn these facts and nor can your patients, so I ask you to be mindful of this in your next consultation. Low mood, anxiety or depression are common in people with long-term conditions. Our aim should be supporting these individuals instead of compounding problems with barren mortality statistics or stories of diminishing quality of life.

Despite the title of this comment piece, I do not believe in ignorance or withholding information. There can be a balance between communicating what a person needs or want to know and maintaining a positive outlook. Consider the difference between teaching your patients and coaching them, and for this we can learn something from the sporting world. Long-distance running coaches take their athletes through difficult and challenging experiences one step at a time. They break it into manageable chunks and feed their runners this knowledge while supporting them every step of the way. We can support and coach our patients through health challenges, one achievement or milestone at a time.

So the next time you find yourself in teacher mode, truly evaluate the person in front of you. What will benefit this individual and promote their health without destroying their future?

Ian Dove is lecturer in adult nursing, University of Bedfordshire.

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Readers' comments (4)

  • Ignorance is not always bliss and medical practitioners should remember, as indeed should nurses that depriving a patient of information can be considered clinical negligence. If a patient learns something detrimental in an untimely and devestating manner which causes harm to them then they do have good grounds to take the case to Court. It is important that patients are able to make informed choices and to do this they need information. To deprive a patient of information leaves them unaware, unable to discuss and possibly unable to ask for a second opinion. Every patient should know enough to understand all possible treatment plans/outcomes. Your article showed you have compassion but I wonder if you have a list of things you wish to achieve in your lifetime?

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  • From a patient perspective, I agree with the article. Particularly in the period soon after diagnosis, I found myself unable to process new information - I just wanted to be able to trust my clinicians and follow their advice. Having more information is good in theory but we have to work with the emotional and mental state of the patient after diagnosis, which will be different in every case.

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  • As someone with a LTC, I would say the starting point should be to ask the patient what and how much they want to know. Different people want to know different amounts, and in different forms. Over and above any vital and life-saving issues (i.e. you must take this medication with fatty food, don't take this OTC medication as it will interfere with your treatment...) engaging the individual in their care in this way will, in most cases, engender the trust and respect that will enable a positive relationship to be created between career and recipient of care. Every person is different, and some people are different people in different situation, so never assume past experience as a predictor of future behavior...

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  • I obtained my medical records from Southend Hospital and was horrified and the list of diagnosis that i was deemed to have, but had been told anything about.
    I had a records that i was a newly diagnosed diabetic ... of which i am not, but other diagnosis included serious heart conditions ... which I do not have! I am crippled with arthritis, but my records say I have no signs of arthritis, which has deprived me of treatment with my pain being managed morphine!

    iI contacted the hospital who were extremely unhelpful and told me once a condition was on my record, it could not be removed. I asked fro an amendment to be added clarifying my situation, they refused.

    I no longer trust what any consultant at this hospital tells me, tells me, it is my body and i have a right to know what is wrong, to allows me to make choices re the best care ./ support i can have.

    Sometimes bad news can be upsetting, but how can we manage out own health and wellbeing if we don't know what is wrong in the first place.

    I have taken charge of my own health, changed my GP to a fantastic one that listens and explains, i have a clear understanding of my condition and the options open to me, and avoid Southend Hospital like the plague. It is any wonder that this hospital has one of the highest death rates in the country?

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