A 2005 study of third-year medical students showed that in a majority of cases where their patients died during their internal medicine rotation, the medical team never brought up death. When they did it was treated only in terms of medical technicalities. The attending physicians only mentioned emotional issues in six of 27 cases.
One physician thinking and writing on the subject created the seminal book, How To Break Bad News: A Guide For Health Care Professionals. In it, Robert Buckman, a Toronto oncologist, outlines six steps in giving out bad news. He starts with setting the scene in a quiet place. Seems pretty obvious to me, but physicians are so focused away from emotions and feelings that the whole thing was ignored until recently. "Hey, pal. You're dying," might have been acceptable for specialists before doctors were expected to be sensitive. Only those Norman Rockwell doctors with the neat, black leather bags, Drs. Welby and Kildare, could do it better.
Dennis Novak, Dean at the Drexel (Philadelphia) School of Medicine related how he had taught himself the practice of giving bad news. "There was one patient who asked me, 'Am I dying?,' and I just said, 'Yes.' I would never say that now." Novak and colleagues at Drexel recently received $200,000 to create "Doc.com", which is making 40 videos that can be downloaded and used at medical schools where scenarios are made using experts and actors posing as patients to start discussions relating to patients and families during these crisis.
But doctors say that no matter how seasoned, some reactions can't be anticipated. "My colleague told a family that their mother was very sick, and the son had a heart attack in her office," says David Muller, dean of Mount Sinai Medical School in New York.
Like many areas where sensitivity is needed in the medical profession, it's about time for a start.
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