A RECENT CONTROVERSY over whether a medical team 'faked' resuscitation attempts on a dead woman has not raised questions about their communication abilities rather than their medical skills. Doctors and nurses have to struggle between tending the sick and dying while dealing with frightened, worried, relatives often fraught with emotion, and perhaps even angry. And for many medical practitioners proud of their medical skills, how to break bad news to devastated relatives remains a difficult process to master. This problem appears to have led to a bizarre situation in which, for the sake of comforting a patient's relatives, surgeons at the North District Hospital were accused of conducting a 'fake' resuscitation on a woman who was clearly dead. On September 9 last year, an elderly woman underwent an emergency operation for duodenal perforation. The operation went wrong and the woman had a heart attack. The Hospital Authority's public complaints committee ruled earlier this month that she had died from complications arising out of the medical team's negligence. The hospital has not yet decided whether there will be any disciplinary action. While still on the operating table, the theatre doctors attempted to revive the patient for about 30 to 40 minutes. They were unsuccessful and the patient's pupils had become dilated and fixed - one sign of death - before they transferred her to the intensive care unit (ICU), where they conducted resuscitation attempts for another hour. Her relatives later complained that the doctors had tried to fool them into believing the patient was still alive. A doctor from the hospital's intensive care unit admitted in a statement to superiors that the one-hour cardiopulmonary resuscitation was carried out 'for the sake of letting the patient's relatives accept the scenario'. 'I was told by the anaesthetist that the patient developed cardiac arrest in the operating theatre about 30 to 40 minutes before and did not respond to cardiopulmonary resuscitation [CPR] in the operating theatre,' the doctor said in the statement. 'However, for the sake of letting the patient's relatives accept the scenario, CPR was continued despite the patient having already had prolonged CPR and having fixed and dilated pupils when she arrived in the ICU.' President of the Public Doctors Association Dr Lai Kang-yiu warns that the North District Hospital case indicated a breakdown in doctor-patient relations. 'It seems that not only do patients and relatives not trust doctors - doctors also no longer trust the patients. It is a very dangerous sign.' The dean of medicine at Chinese University, Professor Sydney Chung Sheung-chee, admitted this was not the first time such futile resuscitation had been carried out. Some doctors went to such effort in order to 'comfort' patients' families. Professor Chung, a surgeon, said there was also a 'bad habit' among some doctors of avoiding the certification of a death in the operating theatre. Some surgeons do not want it known that a patient has died in their theatre as it may suggest failure on their part. 'They would wait until the deceased was taken out of the operating theatre. I don't condone such a practice.' Professor Chung said he had encountered this personally. Some years ago, he was working in a local hospital when a patient he was operating on died in the theatre. A nurse asked him whether he wanted to certify the death inside or outside the theatre. Professor Chung, who had previously trained overseas, said he found the question 'very bizarre. The nurse said it would be better if we took the body out of the operating theatre first before we certify'. He refused to comment directly on the North District Hospital's incident, but said: 'If doctors have to fake resuscitation, it indicates a breakdown in communications. If a patient dies on the operating table, what the doctor should do is to walk out of the theatre and tell the whole truth to the patient's relatives and friends. There is no way for any cover up.' Complaints committee members also consider it 'unethical' for doctors to conduct 'prolonged and unnecessary' resuscitation. Ho Hei-wah, director of the Society for Community Organisation which runs the Patients Rights' Association, said such cases were a cause for concern as it could be construed that the true cause of death was being covered up. The authority's ethics committee has been asked to consider whether new guidelines on resuscitation are needed. The existing rules, written in 1998, state that CPR is not an option for patients who almost certainly will not benefit from it and 'doctors are not obligated to provide medically futile therapy when asked to do so by the patient or patient's family'. It also states doctors should be sensitive to relatives' feelings when discussing medical decisions. Despite these well-meaning guidelines, doctors are faced with extraordinarily difficult situations. Overwrought relatives even accuse doctors of not trying hard enough to revive a loved one. 'More commonly, relatives blame us for not performing resuscitation well enough or giving up too early,' one doctor wrote on the Public Doctors Association's Web site. 'It seems that both giving up too early and prolonging resuscitation will invite complaints. What should we frontline staff do? The problem seemed to be a lack of trust on both sides, the doctor said. Another doctor wrote that relatives have pushed medical staff into performing resuscitation. 'They said they would raise a complaint if we did not do as they hoped. This indicates that our clinical judgment is already controlled by their complaints.' Professor Peter Lee Wing-ho, a consultant clinical psychologist at the University of Hong Kong, says he has counselled doctors disturbed by patients' demands.'