By BBC Doctor Colin Thomas

Honesty is always the best policy, or so I was led to believe, but I've learnt that sometimes caution is necessary before unleashing the powerful, and sometimes destructive weapon that is truth.

A few years ago I had been regularly seeing a patient with cancer.

He was under treatment, and over a period of about a year he had been in hospital for surgery, chemotherapy, and radiotherapy which had all to some degree helped his problem, but had not unfortunately eradicated his tumour completely.

He desperately wanted to continue at work because, in his terms, this meant he was well.

When I had previously seen him we had openly discussed his cancer, treatment, and the various levels of success or failure that might be attached to each, but overall had kept a very positive frame of mind about the whole thing.

He remained well for some months but then unfortunately he developed further spread of his tumour, he lost weight, and became more unwell.

Purely palliative

He was attending for further chemotherapy but it was clear to me that this was purely a palliative measure not designed, or likely, to be curative in any way.

Now, during my training as a student I was taught that if a patient asks you a direct question, then they are requesting a direct answer, and you should reply honestly.

Out of the blue he fixed me with his eyes and said: "I am going to be alright, aren't I doctor?"

Alarm bells rang - it was certainly clear to me that a very sick man was sitting in front of me. Surely he knew the score - but why was he asking me now?

I desperately reverted to my training, identifying this as the direct question, and therefore one that required a direct answer.

"Well, it looks pretty serious to me and, I'm afraid, I don't think there is much hope now of you getting better," I replied.

However instead of the "Thank you for being straight with me Doc" response I was expecting, I was greeted by a barrage of abuse.

"How can you say that? How do you know, you're only a GP. How dare you."

Enraged

He was obviously enraged, and the consultation ended abruptly.

I did feel very bad afterwards I must say, and unfortunately he died just a few weeks later.

On reflection he was a very sick man when I saw him and I don't think he really knew the significance of what he was asking me.

I had seen this as a cry for the truth, but obviously I had missed the mark on this occasion.

It is always difficult to know how honest to be with patients. I must say my gut feeling is to be truthful because little lies tend to get bigger.

In the past doctors did tell half truths to protect their patients feelings, but now in today's medical world that is less of an option.

But does the patient always want the truth? Obviously not.