Would you call that a honest demand?

I wouldn't.

In ordinary circumstances, a patient would never ask that from 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 her health condition.

Really never?

It CAN happen that doctor, quite unsure about a possible bad evolution in his patient's condition, prefers to keep quiet.

But when patient's condition has obviously been worsening, she guesses very often that her doctor is trying to hide her his opinion about her situation.

And then, sometimes, she finds courage to ask him, in fact to beg him:

"Tell me truth, doc!"

What does she really mean? Most probably this:

"Stop, please, hiding me what you really think about possible evolution of my illness!"

And such a demand is a very serious one when doctor is actually concerned with possible nearby death of his patient!

What can he tell her without risking to loose or -- at least - seriously damage her trust in his sincerity?

Should he talk her about statistical probability of her Survival? I don't think it would be a wise answer.

The Medical Faculty taught him that an average patient at this stage of evolution of this special illness will probably be dead before so many weeks, months or years.

Probably "average" patient, yes. But is SHE one of these average patients stats tell us about?

Okay, MOST patients will behave according to stats. Let's say 90%.

But remaining 10 %? What will THEY do?

Let's assume that 5% will die earlier, maybe much earlier. But 5% -- at other extreme of probability curve - will live much longer. Maybe not die at all (at least from this disease.)

One talks then often of a medical miracle. But it's nothing more than a totally foreseeable statistical phenomenon: exception that "confirms rule".

Not SO exceptional either: one on hundred 'members' of Stats 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 illness will develop in HER case. I can just make suppositions -- for and in myself.

Nothing I can tell her, of course. But I owe her an answer!

A quick college statistical, nevertheless? Maybe. But not every patient can be satisfied with such an vague answer.

She wants to know HOW SHE will DO in nearby future. She doesn't care about ONE'S ILLNESS where scientists always talk about.

I could talk her - I did that several times during my career as a family doctor -- about really life endangering present stage of her illness. That she possibly could die, not so far away.

BUT that her WILL to fight for her life, even in this dangerous moment, can make that SHE won't die, that she will make true 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 by whom a quickly developing colon cancer had been diagnosed.

When he asked me how long Faculty gave him to survive his 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 help of some expensive but very efficient holistic drugs. A month before he collapsed, he spent a beautiful summer holiday with his family in 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 lessen pain and died very serenely a week later, short after a nice farewell ceremony from his family which he asked parish priest to organize around his bed.

This is of course way many of us would prefer to die. Not everybody however wants to stay as conscious till utter end.

Not every patient can stand naked scientific "truth" about her nearby death. Many less courageous people will receive from their doctor a different version of truth they maintain to claim.

The duty of 'accompanying' doctor is to evaluate and to reveal to each patient amount of "truth" she is able to cope with. Not more but certainly not less.

Each patient is a unique person who deserves an appropriate and even unique answer to her solemn request. Only a sound knowledge of her psychological - and spiritual - needs can inspire 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 fore last minute. Choose in time doctor whom you will be able to ask -- in full trust that he won't lie or hurt you -

-Tell me truth, doc!

============================================= I hope you won't mind if I make now a few 'philosophical' or linguistic' reflections.

HORMONE REPLACEMENT THERAPY AND BREAST CANCER: THE RISKS IN PERSPECTIVE

Janet M., a fifties-something woman, entered my office and said as she sat down, "I've read that if I take hormones I'll increase my breast cancer risk. I'm going crazy without sleep and with these mood swings, but I don't want to increase my breast cancer risk by taking hormones."

Like many women, Janet had heard that a recent study, Women's Health Initiative (WHI), definitively showed that hormone replacement therapy (HRT) increases breast cancer risk. Janet, like most people, didn't realize that this study found no statistically significant increase in breast cancer risk to women who took HRT.

When differences are not significant, an increase in risk may well be due to other factors, not one being studied, such as HRT use. As often happens when a medical story is reported, emphasis was on increase in risk, not whether increase was likely to be due to agent being studied or to size of risk.

The actual size of a risk is important in any woman's decision making process. In this case risk was exceedingly small -- only 8 in 10,000 women a year -- which is 0.08% or eight hundredths of one percent! Janet was amazed to learn actual size of increase, and said, "You mean I was getting all concerned for a risk that small!"