How to approach a patient with an incurable disease: Dr. YK Amdekar
M3 India Newsdesk Sep 18, 2019
Incurable disease is still treatable though may not be with specific curative drugs. In such instances, there may be other approaches a doctor can take as part of disease management. Moreover, knowing that the doctor is around may help make the patient feel better.
Concept of “cure”
The word “cure” comes from the Latin word “cura’ meaning care, concern or attention. Rational medical practice includes care, concern and attention in the management of every disease. Thus, in the literary sense, it should be possible for every doctor to “cure” every disease. However general expectation of “cure” refers to healing of damage caused by disease with complete functional recovery and regaining the original state of health. But in medical parlance, “cure” is considered when there remains no evidence of active disease at the end of complete treatment irrespective of persistent functional disability.
What is incurable disease?
Medically speaking, a disease is considered incurable when no more medical intervention is likely to help further recovery. However there exists non-pharmacological and non-surgical modalities of treatment other than medical interventions and doctor should not give up before trying them. For example, Down’s syndrome cannot be cured but such a child can be helped in various other ways such as physiotherapy, occupational therapy and other rehabilitation measures and can lead a near normal life.
Many diseases are controllable even if not curable and if well controlled, person can lead normal life with or without continued management. Diabetes and asthma are common examples of such controllable diseases. Many immunological disorders may get into remission by itself and remission may last even forever.
It is important for all of us to realise that it is a patient’s immune system that cures the disease, albeit with the help of a doctor and his treatment modalities. However if the immune system does not act favorably, even completely “cured” infections such as Tuberculosis may be fatal due to immune-mediated complications. Thus, it is clear that incurable disease may still be treatable with the hope of natural control if not cure.
'Incurable' does not mean untreatable. By convention, incurable disease suggests bad prognosis for life. However correctly speaking, it means science is unable to cure the disease, but the immune system or nature or luck or destiny may be able to control if not cure. Finally, today’s incurable disease may find a cure tomorrow.
Dealing with an incurable disease
Once the disease is considered to be incurable, the next step is to find out whether the disease can be controlled or if it is possible to slow down disease progression. In such situations, the aim is to make the patient as comfortable as possible with the quality of life maintained to an extent feasible. This is done by nutritional support, hygienic measures, relief from pain if any and psychological boosting provided by family and friends. All such measures can make a difference to the ultimate outcome.
Counselling a patient with incurable disease
Counselling refers to guiding and offering moral support to a patient so as to help him go through the ordeal. It is well-known that the mind helps the body recover. Counselling is an art that is to be learnt by oneself. Unfortunately it is not taught in medical schools. One should not spell helplessness even in incurable disease.
Finally “I treat and he cures” is the faith in our religions that most patients understand. Though near relatives must be informed fully about the incurable disease, but not the patient directly. It is enough for the patient to know that you have not given up because you have seen many such patients recover well. Once the patient knows that his doctor is with him, it gives him a moral boost. We owe that much to our patients suffering from incurable diseases.
Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.
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