From truth telling to truth in the making: A paradigm shift in communication with cancer patients

Abstract

Direct observation shows how traditional narrow biomedical conceptions of truth in medicine, coupled with increasing technological sophistication and the consequent fragmentation of care practiced under major economic constraints, run parallel to a loss of humanism and of satisfaction for both partners in the patient-doctor relationship. A new conceptualization of truth in medicine, and of communication about it, is needed to restore the integrity of clinical practice, medical education, training, and health care policy. Multiple truths are at stake in clinical medicine, different and yet interrelated. These truths are shared by both partners within the patient-doctor relationship, rather than being simply discovered or imposed by health professionals. A nuanced understanding of the truths at stake in clinical medicine as essentially relational, dynamic, provisional, and situated gives raise to a paradigm shift from truth telling to truth making. This can not only improve communication between patients and their oncologists, but also affect perceptions, attitudes, and practices of education and training, as well as public perceptions of emerging aspects of cancer care and policy making with regard to minority cancer patients and survivors, elderly cancer patients, or mutation carriers.