Health Care's Moral Dilemma

There are all kinds of bad news in life.

You don't get into the college you want. Your girlfriend or boyfriend says, "We have to talk." Your boss says someone else is getting the corner office.

Then there is hospital bad news -- the life-and-death kind -- the kind that Rhonda Fishel has to deliver to patients in her care.

Fishel has been a surgeon for nearly 30 years at Sinai Hospital in Baltimore. She's given a lot of thought to the ways that doctors -- she and her colleagues -- tell patients some of the worst news they'll ever receive: that the doctors can't save them.

"The end of life is death -- even in America," Fishel said. "We all die, and bad news befalls all of us."

To Fishel, delivering bad news is an art in a medical world mostly ruled by science.

In a realm ever more dependent on technology and specialty, the common human touch may matter more than ever. Not every doctor has mastered it, though.

"For years I've had to give patients bad news, and I have thought a lot about how we do it," she said.

"There are days when you are very proud of how you interact with patients, and there are days when you are rushed or irritated and it may not be optimum."

When the Doctors Don't Break the News Gently

Lutricia Wolff, who is now one of Fishel's cancer patients, remembers how her first doctor broke the news of finding a cancerous lump.

"'It's cancer. I'll tell you that right now.' And I started crying. And he asked me, 'I don't know why you're so upset. You're small chested, anyway,'" Wolff said.

"I've had some cold, cold doctors," she said.

It may sound unbelievable, but Albert Aboulaifa says he's seen it since his earliest days as a resident.

Aboulaifa, also a surgeon at Sinai Hospital, described how one doctor casually smoked at the nurse's station when a distraught woman asked how her husband was doing.

"He had just taken the last drag off a short cigarette. … Dropped it on the floor [and said], 'He's dead.' I will never forget it," Aboulaifa said.

ABC News was standing by as Aboulaifa worked through a painfully tense bad news moment with a cancer patient named Leroy Jackson.

He had to tell Jackson about the cancer they had taken out of his body.

Aboulaifa thought he'd gotten all of it, but it was a more threatening kind than originally believed -- throwing Jackson a punch he hadn't expected.

"So is this going to take my life?" Jackson asked.

"It can, but I'm hoping it won't," Aboulaifa said.

Aboulaifa sat eye-to-eye with Jackson for the better part of half an hour, talking it through.

Perhaps it's not surprising that an already difficult task is even harder for surgeons.

There's a stereotype about surgeons that says they are particularly awkward at dealing with patients on a personal level -- the patients they're accustomed to dealing with are knocked out, asleep under anesthesia.

There's also the plain fact that most surgeons are so overworked and sleep-deprived just doing the surgery that sometimes they don't have much left for the intense emotional rigors.

Susanna Matsen, a resident at Johns Hopkins Hospital who studied under Fishel, offers another explanation.

"In the hierarchy of medicine, that's not how you advance. You don't get ahead by being able to give bad news well," Matsen said.

What Do Patients Deserve? Doctors' Best Practices

What does a surgeon owe a patient beyond a well-performed surgery, in terms of the human side of it?

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