i have just returned from the most spectacularly interesting class about ethics in health care, and mostly what made it interesting to me was the case studies of two women with breast cancer. One in the USA and one in Japan.

The USA study was fairly parallel to here. It was the Japanese case study that really captured me. One doctor was trying to overcome a cultural tendency to shield patients from the truth. Apparently, Japanese doctors have historically avoided giving people bad news, especially if it's cancer, because there is a belief that people will fare better if they have hope and a positive outlook.

They showed a typical case: They tell Mrs. Yakimoto that she has an ulcer in her stomach and she has to go for some surgery but she's fine.

And then they send her out of the room for some "tests."

And while she's gone, they tell her husband that she has horrible stomach cancer, they'll have to take out her entire stomach, and her chances of survival are 30%. And that he shouldn't tell her because it will make her lose hope and she'll be more likely to die. Then they call the patient back into the room, and the Yakimotos go home, and Mr Yakimoto has to make smalltalk all the way home and pretend that the bottom didn't just fall out of his world.

*

So another doctor, trying to combat this tendency and provide more information for patients, tells a family about their wife/sister/niece's breast cancer. He removes the woman's breast, and then while she's in the recovery room, he comes to see the family and provides a long technical explanation about the exact odds and treatments and risks.

And then he reaches into a box, and pulls out the breast he just amputated. He places it on the table and shows them the tumour, and how it was eating at the ducts leading to the nipple, and how it interacts with the armpit muscle (also on the table).

I couldn't take my eyes off of it. Since my mother's mastectomy I always wondered what it all looked like... and tonight i saw this big bloody hunk of disembodied breast tissue [on video], all fat and skin and cancer, and it was all a little weird.

Almost every woman in the audience instinctively reached for her breast, as did the sisters and the aunt in the video.

[This is not general practice in Japan, it was just something that they found somewhere and decided to show in graphic detail on video, and our prof thought it would be somehow instructional.]

ps. general agreement that telling people by shocking them is about as helpful as not telling them at all.

pps. and they pulled out all these cool experts to talk about stuff: health psychologists, and medical anthropologists, and i didn't even know these things existed. Fantastic.

10:14 p.m. - 2003-01-27