what do you tell a terminal patient?

[clkt]

That question seems to be popular. What the heck does that question tell the interviewer about you? Of course you are going to say "dude, you are gonna be dead". Is there a catch here?

[momo]

Having volunteered in palliative care for many years, I think the catch is to say it in an empathetic yet informative and honest manner.

 

There is a physician in Hamilton, Dr. Elizabeth Latimer, who has presented and written much on the subject of approaching palliative care issues and if you can get a hold of her information it's priceless. I've had the pleasure to hear her speak and she's quite inspiring.

[muchdutch]

Perhaps the interviewers are just looking to see the depth and maturity of your answer. Aside from saying what you said, which I'm sure most people wouldn't say, there are probably quite a range of ways to break this type of news to a patient depending on the circumstance. They are probably just looking to see if there's any compassion within your response is my guess.

[ffp]

When you actually start your clerkship/residency, you will get used to breaking bad news very quickly. It's always tough to do, though.

 

First of all, most patients are surprisingly prepared to hear what you are going to say. they may not know they have a terminal illness, but a lot of the time they are expecting something BAD, and you are just confirming what they already suspect/know. Many people are relieved just to hear it straight out.

 

If this was presented as an interview/exam scenario... I would make sure the patient was comfortably seated. If there is family in the room, ask the patient if he/she would like them to stay.

 

Begin with something like "Mr. X, we got the results from your biopsy back today. It looks as though the cancer has spread. Unfortunately, chemotherapy is not an option now. The cancer is not curable".

 

The patient will have questions: "How long do I have?" You can quote average survivals for their particular condition if you happen to know, but explain that each case is unique. There is no way of knowing for sure.

 

What can I expect from the dying process? Will it be painful? If you've never seen a patient die before, you can't exactly answer this question, but make sure they know they are not alone. There are excellent palliative care resources to discuss these issues with patients and family members. We can control pain and discomfort. Make sure you offer to refer them to palliative care/social work/psych if needed.

 

Some patients are angry or in denial. This is normal and ok. Acknowledge their anger. "You're right, this really isn't fair". Some patients will ask for second opinions, or want to pursue alternative therapies. Let them know that these alternative therapies haven't been studied - they could just be throwing money away or using something that can cause more harm than good. On the other hand, if conventional medicine has failed them, alternative therapy might be a feasable alternative. Be supportive of their decisions.

 

Make sure you speak slowly and make eye contact with the patient and any family members the whole time. Always be open to questions. The main thing is LISTENING to the patient and the family and being supportive.

 

Hope this helps.

[Jochi1543]

Wow, ffp, another great informative post.

[muchdutch]

make eye contact with the patient and any family members the whole time

 

Very important. I remember every thing that happened when my doc broke some bad news and she didn't make eye contact at the time she told me the news. I distinctly remember that. She was just out of residency and I would have thought that she would have done that before, but it didn't seem like she really had, or at least not on her own.

[clkt]

wow, thanks ffp, very insightful post!