fbpx
Wednesday, May 27, 2020

On delivering bad news

Enjoying this article?

You'll love our roundtable.


By submitting this form, you are consenting to receive marketing emails from: Jewish Journal, 3250 Wilshire Boulevard, Los Angeles, CA, 90010, http://www.jewishjournal.com. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact

Delivering bad news is part of my job, an important part.

It is fashionable nowadays to speak of the doctor-patient relationship as a partnership. In the sense that both doctor and patient have important roles to play for the patient to get good care, that’s very true. But even in the best of times, it’s a very asymmetric partnership. Even in a run-of-the-mill visit for a sinus infection the patient and the doctor bring very different skills, experiences, and expectations to the encounter.

The more unexpected and unusual the clinical situation is, the greater the asymmetry between doctor and patient. A perfect example is benign positional vertigo, which is common enough that primary care doctors see it all the time, but most patients have never heard about it. The symptoms are scary, but the prognosis is fine. Ninety percent of the time all that is needed is a careful examination and some reassurance. The patient and the doctor come to the encounter with completely opposite attitudes. The patient is terrified by the vertigo and has never heard of anything like this. Is it a stroke? Is it a brain tumor? For the patient, it’s the first time he’s had vertigo. For the doctor, it’s the hundredth case he’s seen. The doctor’s job is just to rule out a couple of rare but serious possibilities and break the good news in a credible but reassuring way.

That’s a picnic compared to delivering catastrophic news. That’s when the ever-present asymmetry between doctor and patient threatens to be a gulf that can not be bridged. The doctor and the patient couldn’t be in more different positions. The doctor has been through this many times before and is not in danger. The patient has never been through this before and has a life-threatening problem. The doctor is thinking of a checklist of tests to consider, specialists to call, treatment options to weigh. The patient is barely processing the bad news.

Much has been written on the art of delivering bad news. There are entire books and classes devoted to the subject. I am certainly a continuing student, not a master, in this field. The key is the understanding that the patient can not bridge the chasm of experience and expectation between him and the doctor; he can’t even meet the doctor half way. He can’t develop the perspective of seeing a dozen patients with the same illness go through treatment. He can’t review the literature about his disease. He will only hear the words “cancer” or “stroke” or “Alzheimer’s” or “ALS” and hear nothing else until the shock wears off. The doctor has to remember that his hundredth time of delivering terrible news is the patient’s first time hearing it.

The surprising thing is the patient’s response. I’ve seen brilliant successful patients retreat behind a fortress of denial, leaving all important decisions to their upset and bewildered family. I’ve seen emotional breakdown, of course. But surprisingly frequently, even when the family expects emotional breakdowns, I’ve seen courage, and calm, and even acceptance.

About ten years ago, a middle-aged man who had been my patient for many years came to see me for some worrisome symptoms. I ordered a test and the following day called him with the results. He had a kind of cancer that usually had a terrible prognosis. A few days later, waiting for a procedure, he said to me “I have no regrets. I love my family. My family loves me. I’ve lived a good life.” He passed away within a month. He was not an old man. He would have been justified in ranting about the decades that were stolen from him. But instead he faced his mortality unflinchingly.

This week I told a sweet older lady that she has a life-threatening illness. Her son held her hand while I rubbed her shoulder. “Might this kill me?” she asked. I told her it might. We’re taking it a day at a time.

The lesson I keep relearning is that delivering bad news is tough. That’s probably a good thing. If it ever gets easy I should retire. The lesson patients keep teaching me is that they’re frequently tougher than anyone expected.

Enjoyed this article?

You'll love our roundtable.


By submitting this form, you are consenting to receive marketing emails from: Jewish Journal, 3250 Wilshire Boulevard, Los Angeles, CA, 90010, http://www.jewishjournal.com. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact

Latest Articles

Man Who Held Anti-Semitic Sign at Ohio Protest Wanted to Target Jews at Kent State, Report Says

A man who held an anti-Semitic sign at an April rally in Columbus, Ohio, reportedly sought to target Jews at Kent State University. The Cleveland...

Bench Near Minneapolis Synagogue Vandalized With Swastikas

(JTA) — A bus stop near a synagogue in Minneapolis was vandalized with swastikas. The graffiti was discovered Tuesday on a bench outside Shir Tikvah...

ADL Report Highlights ‘Significant Trend of Anti-Semitism’ in ‘the Anti-Israel Movement on Campus’

The Anti-Defamation League (ADL) released a report on May 27 highlighting how anti-Semitism permeates “the anti-Israel movement on .” The report acknowledged that although the...

A New Relief Fund Is Providing Aid to Jews of Color Who Are Struggling Due to Coronavirus

(JTA) — A new relief fund is providing financial aid to Jews of color who are struggling economically due to the coronavirus pandemic. The Jews...

Pandemic Times Episode 47: The Value of Storytelling

New David Suissa Podcast Every Morning at 11 a.m. A conversation on the unique power of storytelling with Rutger Bruining in London, founder of Story...

Obituaries: May 29, 2020

Beth Abramowitz died May 12 at 54. Survived by mother Barbara; father Abraham; brother David. Hillside  Louis Bauman died May 7 at 84. Survived by wife Myrna;...

Letters: Jewish Virtual Weddings, Masa Israel’s Legacy 

Prager’s Lockdown Story Dennis Prager’s “The Worldwide Lockdown May Be the Greatest Mistake in History” (May 8) validly complains that the left too often dismisses...

American Jews, This Shavuot it’s Time We Rededicate Ourselves to Social Justice

In April, we celebrated Passover during a modern-day plague. Over the past two months, the world has seen the horrors of that plague unfold....

Holidays and the Environment: From Shavuot to Dairy to Desalination

To prevent public gatherings during COVID-19, Lag BaOmer took place without bonfires, resulting in a significant reduction in air pollution. Now, Shavuot will be...

Israeli Defense Ministry: Gaucher’s Disease Drugs Can Treat COVID-19

The Israeli Defense Ministry announced on May 26 that the Israeli Institute for Biological Research (IIBR) has determined that two drugs used for Gaucher’s...

Culture


‘Love & Stuff’ Sees Life, Death and Motherhood Through a Jewish Lens

How do you cope with both the death of a parent and the artifacts she left behind, while preparing to become a mother yourself...

Jews of Color Campaign Goes Viral After Article Relegates Them to a Statistic

Numbers have always held significance in Jewish culture, but without purpose, they can be harmful. This was borne out in a May 17 eJewish...

A Savory Shavuot Feast With a Sweet Finale

It was a sacred tradition. We would load up our minivans with lots and lots of food and our kids and head to the...

Why Summer Camp Is So Important to American Jews

Every summer, tens of thousands of American Jewish kids leave their homes, board buses and planes, and spend a month or two together on...

Diane Warren’s ‘I’m Standing with You’ Music Video to Raise Funds for COVID-19 Response

“I’m Standing with You,” songwriter Diane Warren’s Oscar-nominated theme from the movie “Breakthrough,” has gone global in a new video in support of the...

Latest Articles
Latest

Man Who Held Anti-Semitic Sign at Ohio Protest Wanted to Target Jews at Kent State, Report Says

A man who held an anti-Semitic sign at an April rally in Columbus, Ohio, reportedly sought to target Jews at Kent State University. The Cleveland...

Bench Near Minneapolis Synagogue Vandalized With Swastikas

(JTA) — A bus stop near a synagogue in Minneapolis was vandalized with swastikas. The graffiti was discovered Tuesday on a bench outside Shir Tikvah...

ADL Report Highlights ‘Significant Trend of Anti-Semitism’ in ‘the Anti-Israel Movement on Campus’

The Anti-Defamation League (ADL) released a report on May 27 highlighting how anti-Semitism permeates “the anti-Israel movement on .” The report acknowledged that although the...

A New Relief Fund Is Providing Aid to Jews of Color Who Are Struggling Due to Coronavirus

(JTA) — A new relief fund is providing financial aid to Jews of color who are struggling economically due to the coronavirus pandemic. The Jews...

Pandemic Times Episode 47: The Value of Storytelling

New David Suissa Podcast Every Morning at 11 a.m. A conversation on the unique power of storytelling with Rutger Bruining in London, founder of Story...

Hollywood


‘Love & Stuff’ Sees Life, Death and Motherhood Through a Jewish Lens

How do you cope with both the death of a parent and the artifacts she left behind, while preparing to become a mother yourself...

‘Arrowverse’ Showrunner Greg Berlanti on Whether He’s Jewish or Not

Greg Berlanti is the executive producer of “Arrow,” “Supergirl,” “Titans,” “Riverdale” and “The Flash.” Between keeping his die-hard DC fans satisfied, the mega-producer also...

Jewish Grandpa Seeks Out The Family Who Hid Him From Nazis in Documentary “The Starfish”

New York director and producer, Tyler Gildin, through his media company Gildin Media, released a documentary titled The Starfish, exploring the life story of his grandfather,...

Podcasts

Pandemic Times Episode 47: The Value of Storytelling

New David Suissa Podcast Every Morning at 11 a.m. A conversation on the unique power of storytelling with Rutger Bruining in London, founder of Story...

Matti Friedman: Israel’s forgotten war

Shmuel Rosner and Matti Friedman discuss Matti's new book, "Pumpkinflowers: A Soldier's Story of a Forgotten War," Israel's war in Lebanon and why it...

More news and opinions than at a Shabbat dinner, right in your inbox.


By submitting this form, you are consenting to receive marketing emails from: Jewish Journal, 3250 Wilshire Boulevard, Los Angeles, CA, 90010, http://www.jewishjournal.com. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact

x