Tell the Truth

A few weeks ago I had a patient that kind of surprised me. 

I was in oncology and an older patient who had presented with neurological symptoms was diagnosed with lymphoma in the brain. If you know anything about this terrible disease, you also know that it's usually related to HIV/AIDS. But, upon taking the patients history the only disease she admitted to having was fifteen years ago when she was treated for syphilis. 

So as she lay in critical care the doctors performed the routine tests including normal blood work and an ELIZA for HIV/AIDS. Her CD4+ count was 3. She had AIDS. 

Two weeks later she was doing much better all things considered. But, still had not been told of her diagnosis. Some classmates and I asked the doctors why she hadn't been told yet and they told us that they were concerned for her mental well-being and her current health state. Both genuine concerns. We were under strict instructions NOT to mention the diagnosis in front of the patient.  

As we sat in the doctors lounge one day near the end of the rotation one of my classmates asked if she had been told. The doctor said that he was going to tell her today. But, he said something that made me think long and hard about this patient.

"I think she already knows. I think she was probably diagnosed when she was diagnosed with syphilis, or at some other point. Most people don't have a CD4+ count that low and not show some preliminary symptoms of some type." 

They took her to a private room to tell her the diagnosis later that day. 

She already knew she had AIDS.  The doctor was right. 

But, why had she not told them? What made her think that it wasn't important enough to share? Was it fear of the stigmatism that HIV has in Poland? Or was it genuine lack of knowledge about the disease itself? 

Universal precautions are always used, but knowing the diagnosis would have made it more important and would have led those who treated her to be just a bit more careful. Knowing the final diagnosis would have also meant that her current diagnosis of brain lymphoma would have been recognized and treated sooner, which would have been better for her. She could have been started on HAART sooner and had radiation sooner, she might have lied and wasted the chance to save her own life. 

No one cared that she had AIDS. The doctors were upset because they had been lied to. They were upset because, she might very well have died had they of not caught it. 

Please, never lie or fail to mention health conditions to your doctors. It might not seem important to you, but to your healthcare provider it might be the minor difference between medications used to treat you or the difference between knowing the diagnosis and not.

It's your life, doctors are just trying to help you save it. Don't lie to them.  


Photo Credits to: http://www.med.uc.edu/neurorad/webpage/gua.html