Dr. Jeff Kane: Delivering bad news
In this pandemic doctors must convey more bad news than ever. And most docs have no training in doing it, which can make for a terrible experience for all involved.
When I was a young emergency department physician, an ambulance delivered a middle-aged warehouse worker whose head had been crushed flat against a wall by a truck. He was so obviously dead that we didn’t attempt resuscitation.
Soon his wife showed up. She asked me, “He’ll recover, won’t he?”
“I’m sorry,” I answered. “He won’t. He died.” Then I went back to work.
My behavior was graceless, devoid of compassion. If a genie offered me a wish today, I’d ask for a re-do. Since that day I’ve learned there was more I could have done, but I didn’t know then what was possible, let alone how to do it.
I try to persuade myself that at least I didn’t make things worse. I heard of one surgeon who emerged from the operating room and told the waiting family, “He died because I had too little to work with.” I’ve heard more horrifying stories, but when I get angry I find myself often excusing errant docs since they had no effective training in merciful speech.
It may shock you that it’s taken medical educators until now to realize how central communication is to medical practice. More and more, instructors are recognizing what patients experience every day: docs who act as though compassion is taboo. Their stoicism is ostensibly meant to protect them — like a pane of glass between them and the suffering that’s their stock-in-trade. But it’s ever more obvious that emotional repression is hazardous to anyone’s mental and physical health.
I’m happy to report that little lights are igniting here and there. At Oregon Health & Science University, for example, students must now be able to show that in addition to clinical skills, they know how to deliver death news, admit a medical mistake, and confidently handle other issues that are rich in emotion and ethics.
As in law, the wheels of medicine grind on slowly. We’ll have to be lenient with the pace of more humane curricula, but their progress is a sure thing.
Jeff Kane is a physician and writer in Nevada City.
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