Friday, September 3, 2010

Family Medicine: Sensitive Death Comments

Two patients in one day commented about physicians mentioning death as one of their potential outcomes with serious illnesses, one in an ER and one in an oncologist's office.  The bluntness of the comments surprised me, so I sought clarification of the actual words used to relay the surprising information (to the patients).

I remember calling a physician in the ER to inform them of my patient coming via squad with extreme shortness of breath and a history of DVT (deep venous thrombosis- blood clots in leg veins).  A few hours later a physician in the ER entered the cubicle where my patient and her caretaker daughter waited (now with an IV and oxygen for the patient).  According to them, the physician said, "We have good news and bad news, we've found out what's wrong with you- you have blood clots in your lungs and you could die." He left before they could say a word.  They were stunned.  And afraid.

The other patient is a woman on the mend from breast cancer.  After the surprising mammogram finding of a tumor and the biopsy showing a common cancer with micro-invasion, the patient underwent lumpectomy and met with the oncologist.  The words she heard were to the effect that, "there's an 80% chance that you need no more than what you have already experienced to be cured.  But we want to do radiation therapy and chemotherapy to improve your odds for survival."  The patient agreed and had a recent visit with the oncologist who said.  "I'm glad you got the Chemo and radiation or you would have probably died."

What happened to the 80% chance that the patient was already cured before chemo and RT?  After the comment by her oncologist, she felt like the 80% changed to zero, so now she is only relying on the chances delivered by the chemo and the radiation.  Her brain is not going back to believe in the 80% comment, since the doctor "erased it".  She lost some of her hope for cure.

Hope enhances t cell and natural killer cell function, decreasing the chance for recurrence of breast cancer, according to good studies.  Killing hope should not be a physician skill, even an accidental one.

 "I apologize for my profession,"  I said to both patients.  I'm sorry we don't do better with our communication about risks and benefits of diseases and therapies.  I'm sorry that we sometimes don't have the right words to impart to the patient what they actually need to know.  I'm sorry that we sometimes terrify people.  I hope we get better at remembering Hope which is one of the "drugs of choice" for most ailments.


  1. I really appreciate this post and your discussing the importance of hope.

  2. Thank you, SeaSpray. Your blog will be my "non-physician" feature on the Dr Synonymous Show on next Tuesday at 8 PM. Peace.