We no longer conceal bad diagnoses from patients; we consider this unethical. It is time that we consider it unethical to conceal that we have nothing to offer beyond palliation.
In theory the point seems to have merit--but I wonder if that is because it is Dr. Cifu saying it, i.e., if I had a doctor like him, I'd be OK with some version of that statement because I would know what it meant. But then giving this permission to the run of the mill harried and poorly trained doctors with various conflicts of interest... well, I'm not so sure.
Is it just a medical "urban myth" that a patient with cancer lives with a fairly decent quality of life for many months but as soon as the doctor tells them their diagnosis of advance stage cancer they are gone within a very short period of time? It is like it suddenly becomes a self-fulfilling prophecy.
"Your cancer has spread to the lymph, we'll of course do a scan to check if it has spread to the brain too... " and before doctor and patient have a chance to discuss if there's any possible treatment the patient has died.
If my memory serves me correctly, there was a case where an oncologist was sued and lost, for failure to inform the patient of the poor prognosis and life expectancy associated with his condition and stage of same. The heirs contended that had their father known about the short time left to live, he would have done more to protect his assets from taxes etc, so, they would’ve ended up with a better slice of the pie. Yes, we have to be upfront about bad diagnoses.
In this era of everything being a specialty or subspecialty, a push for more RVU’s produced, it’s difficult to find a practitioner that will be willing or able to care for patients at end of life. Thus the phrase “ there’s nothing else we can do “ isn’t truly applicable. We can take care of the pain, if the pervasive narcophobia doesn’t leave us only Tylenol as an option. We can use benzodiazepines and atypical antipsychotics, even if off-label or not recommended according to the “ guidelines “, for the behavioral changes expected from the condition, allowing the patient and the burning-out caregivers a better quality of life. Always remember that you aren’t just treating the person whose chart you have open. The day I am dying and in pain, do NOT show up with Toradol and chamomile …. I will come back to haunt you !
In theory the point seems to have merit--but I wonder if that is because it is Dr. Cifu saying it, i.e., if I had a doctor like him, I'd be OK with some version of that statement because I would know what it meant. But then giving this permission to the run of the mill harried and poorly trained doctors with various conflicts of interest... well, I'm not so sure.
You’re right. Not me (despite writing these I’m not that self important) but the essay is set in “the best of all worlds…”
Is it just a medical "urban myth" that a patient with cancer lives with a fairly decent quality of life for many months but as soon as the doctor tells them their diagnosis of advance stage cancer they are gone within a very short period of time? It is like it suddenly becomes a self-fulfilling prophecy.
"Your cancer has spread to the lymph, we'll of course do a scan to check if it has spread to the brain too... " and before doctor and patient have a chance to discuss if there's any possible treatment the patient has died.
Given the powerful effects of compassion empathy and the placebo effect I think “there is nothing left to do”
Should probably rarely if ever be an option.
Sometimes, the greatest gift we can give is to let go. True in Medicine and true with our loved ones.
If my memory serves me correctly, there was a case where an oncologist was sued and lost, for failure to inform the patient of the poor prognosis and life expectancy associated with his condition and stage of same. The heirs contended that had their father known about the short time left to live, he would have done more to protect his assets from taxes etc, so, they would’ve ended up with a better slice of the pie. Yes, we have to be upfront about bad diagnoses.
In this era of everything being a specialty or subspecialty, a push for more RVU’s produced, it’s difficult to find a practitioner that will be willing or able to care for patients at end of life. Thus the phrase “ there’s nothing else we can do “ isn’t truly applicable. We can take care of the pain, if the pervasive narcophobia doesn’t leave us only Tylenol as an option. We can use benzodiazepines and atypical antipsychotics, even if off-label or not recommended according to the “ guidelines “, for the behavioral changes expected from the condition, allowing the patient and the burning-out caregivers a better quality of life. Always remember that you aren’t just treating the person whose chart you have open. The day I am dying and in pain, do NOT show up with Toradol and chamomile …. I will come back to haunt you !
I might put “The day I am dying and in pain, do NOT show up with Toradol and chamomile …. I will come back to haunt you!” In my advanced directives.