Saturday, December 6, 2008
Should The Doctor Say You Are Dying?
Most Oncologists say they would tell a terminally ill patient that they will die. But in the same survey of over 700 Oncologists, published in the Journal of Clinical Oncology, it was revealed that 48% of the doctors would talk about death only when their patients said "yes" they wanted to talk about it. Also, less than half of the oncologists (43%) said they would give an estimate of the time a patient has left to live. Yet 74% of those same doctors said THEY would want to know their prognosis, including a time frame of when death could be expected.
We are a society that is very uncomfortable with death. We offer unrealistic expectations of survival in patients with advanced terminal cancer and patients with end stage cardiac or pulmonary disease. There is always "one more" new drug or hospitalization that can be offered and physicians and families do not want to take away "hope". Doctors are stuck between a rock and a hard place because patients don't want to be"quitters" and they don't want a physician who will give up.
It is far easier to offer another course of Chemo than to have the difficult conversation that says; "This time with your family is important time. Chemo will make you feel weak and sap your strength and you will be on medication that will make it hard to think and communicate and enjoy your life. I would rather help you have as much strength and energy as possible and line you up with Hospice programs that can help with your symptoms and equipment needs so you can be at home. I will continue to be your doctor and we can change our mind at any time if new treatments are available or if it looks like things are improving."
Eighty percent of all deaths occur in a hospital. How would you like to spend your last days?
Posted by Toni Brayer, MD at 8:58 AM