Health Care's Moral Dilemma

What does a surgeon feel he or she really owes the patient? ABC News asked Fishel.

"I think that you really owe it to them to explain the information to them in a language that they can understand," Fishel said.

"And when it is really bad news … a setting where you have time for them."

What that means in practice can vary from person to person, but the doctors we talked to had concrete examples of methods they use, including ones that are simple and concrete.

Just making sure everyone is sitting down shows respect for the situation, Fishel said.

"Something as simple as handing someone a Kleenex is something that I have learned," Aboulaifa said.

There are also more subtle tactics, such as not telling people everything at once.

Dr. Matthew Stewart of John Hopkins Hospital explains one such scenario:

"You go in with your first session with the family and say, 'These are devastating injuries.' And then you stop there, and let people come to grips with that. And that lets you introduce in a later meeting, the ideas of how would this person like their end of life to be."

In short, it means understanding that not everybody is a "give it to me straight" kind of patient.

Hopeful, but Honest

Patients "want you to be hopeful, but they'd like you to be honest," Fishel said.

Not all doctors will meet that standard.

Not all patients have been told the bad news in a way that was best or easiest for them.

But meanwhile, Fishel has turned her passion about breaking bad news well into a mission.

"No matter where we go with technology, we always have to deal with something that can't be fixed, and a person that can't live forever," she said.

"To make that more comfortable for the patient and more bearable for the families has got to be one of our main priorities."

Rhonda Fishel can be reached at Sinai Hospital

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