After talking to some friends about the process of delivering horrible news, I need to add a few things. When I say horrible, I mean there's no chance for recovery. If there is a chance for recovery, albeit slight, you have to tread a little more carefully.
But there are certain things that must be avoided. Never use the following phrases:
"We'll keep fighting"
"Do you want us to give up?"
ANY sports analogy
Quit, throw in the towel, give up, stop trying, surrender
Never make it a choice between life and death
I say this because it's important to understand that letting someone die peacefully takes a lot of courage. It takes a strong will to say, 'No. S/he wouldn't have wanted this.' Because you're not asking for a family to decide if their loved one should live or die. That's just not fair.
In most cases, you're asking the family to see that the focus of treatment needs to change, that treatment isn't making the patient any better, and so we must redefine what 'better' means. Better can mean cure, but better can also mean at peace or comfortable or right with God or any number of things, and it's important to help a family realize that if we can't make a person medically better, we need to think about these other better's and maybe think more about that.
I'll admit, I get palliative care involved very early in a case where the patient is in my opinion without hope for recovery. And it's important to know that palliative care isn't about giving up. It's quite the opposite. It's a determined and concerted effort to make someone feel better.
For a long time I have enjoyed reading your blog. However, now it seems all you do is talk about how delicate, kind, and righteous you are as an individual; it smacks of pompousity and something vile. compassion and empathy are best displayed in action, not in word. yes you are probably not getting the recognition you deserve for your truly great actions, but damn, this blog has become a self-esteem booster for you and nothing else. maybe that's what you want, but you appear by all accounts to be capable of great discernment, true devotion to medicine, and a meaningful connection fdaslkj;sdja lskdj blah its pointless.
ReplyDeleteIt's funny how many times I end up saying this. I don't write this blog for anyone except myself. Sorry you don't like the current content, but it is what it is.
ReplyDeleteThe things you write about make me think, PGY-2. That's a good thing for a person who is going to be a doctor in about 2 months. You write about what works for you in practice, and I appreciate your insight.
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