How Doctors Tell Patients They're Dying

Telling a patient they're dying is one of the toughest jobs for a doctor.


March 7, 2008 — -- Telling patients they're going to die is less dramatic than one might think, and contrary to popular belief, most doctors refuse to estimate how many weeks or months patients have left to live.

While initial reports of Patrick Swayze's pancreatic cancer diagnosis came with predictions that the star would have only five weeks to live, the actor's doctor quickly released a statement refuting the rumors.

"Patrick has a very limited amount of disease, and he appears to be responding well to treatment thus far," Dr. George Fisher, Swayze's physician, said in the statement. "All the reports stating the time frame of his prognosis and his physical side effects are absolutely untrue. We are considerably more optimistic."

Putting a time stamp on someone's life, several doctors told, is something that few doctors are willing to do. Instead, they employ much more methodical and caring techniques of breaking the news to terminally ill patients.

"It's not [a doctor's] job to take away hope but to try to provide support and be realistic as possible," said Dr. Michael Grodin, the director of medical ethics at Boston University School of Medicine and Public Health. "We are notoriously bad at predicting how much time a patient has left.

"You can obviously say that if someone has metastatic cancer that it's unlikely they're going to live for years," said Grodin, who said that it's always "very tough" to tell a patient he is dying. "But then again I've seen time and time again patients living much longer [than predicted] or dying much sooner."

Many patients fear abandonment, Grodin said, so doctors must be sure to take the time to remind their terminally ill patients that even though a cure might be out of the question, their health is still important to them.

"Once they're diagnosed as terminal they worry that because we have nothing to do for them [in terms of a cure], we'll desert them," Grodin said. "So we must tell them that 'we have many wonderful things to do for you so that you don't have the pain and the suffering.'"

Grodin, who trains residents on how to tell patients they're dying, told that doctors must be as straightforward as possible when delivering the news.

"Don't use euphemisms," said Grodin, who teaches his students to say "died" and never "passed away" in situations of emergency room traumas. "You have to use the words 'terminal illness' and explain it's quite serious."

But what about those patients who want to know how long they have to live and would prefer a more precise answer from their doctors? Dr. Nick Christakis, a professor of medical sociology at Harvard Medical School, said doctors should cater to that individual's needs and be as honest as possible.

"Some patients say they don't want to know anything, and others say, 'Give it to me straight, doc,'" Christakis said. "Once you've established what kind of patient you're dealing with, you should be as willing to be as specific as science allows."

Even then, though, reminding patients that there are always exceptions to a doctor's prognosis is important, Christakis added.

While telling patients they're going to die is arguably one of the hardest parts of being a doctor, being on the receiving end of the news is certainly not easy, either.

"There's an overall pattern of how humans deal with forthcoming death," said Sherri McCarthy, a professor of psychology and a grief counselor at Northern Arizona University. "Shock or denial is a pretty universal first reaction. Patients say 'it's not me' or 'I'll go to a different doctor.'"

Eventually, these feelings usually transform into depression or anger, McCarthy said, and then later into "bargaining," a term used to describe when patients try to rationalize the situation and convince themselves they can do certain things to prevent their death.

And when they've finally accepted their illness, what happens next depends largely on the individual patient, McCarthy said.

"With people who have the freedom to [quit their jobs], it's common to see redirection," McCarthy said. "They're likely to think that they only have a limited time and say, 'I only have so much time to do the things I really want to do.'"

Dr. Ken Doka, a senior consultant to the Hospice Foundation of America, said that everyone copes differently, and often people deal with death similar to the way they deal with other aspects of life.

"We die as we live," Doka said. "If we're an angry person, then we tend to get angry at this. Some will cope by ignoring it and going on about their life as best they can, others will frantically look to do everything they can to try to beat it."

Said Boston University's Grodin, "We deal with death and dying daily as doctors. But most other people don't. There's this assumption that people know how to do it.

"There are as many people as there are ways people die," Grodin said. "You must take each case as unique and separate."

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