"What does this mean?"
I was sitting across from one of my Dad's oncologists, clutching photocopies of all of my Dad's recent imaging studies and his surgical pathology report, looking for answers. When my Mom and Dad had met with her a day earlier to review the results, the oncologist had waxed poetic about a similar patient who was still playing golf five years after his diagnosis, but I wasn't buying it. Although I was only a third-year medical student at the time, I knew that phrases like "14 out of 29 lymph nodes positive" and "extracapsular spread" and "suspicious for diffuse bony metastases" were not used to describe someone who would be playing golf in five years time.
"Pardon?" she asked, pretending not to understand my question in the hope that it would go away.
"What is his prognosis?" My directness made the oncologist squirm in her seat and start scribbling furiously on a chart so that she wouldn't have to look me in the eye.
"Oh, well, it's always so hard to tell. Why, I know a person just like your Dad who's still playing..."
"I understand that. What I want to know is, on average, what is the life expectancy of someone whose melanoma is as advanced as my Dad's?"
"Oh, well." She was really flustered now, staring intently at her silent pager as if she could make it go off through shear will. "It's really hard to say. Everyone is different."
"Fine." I realized I was getting nowhere. "What stage is his disease?"
"Stage IIIC" she replied, seemingly more comfortable with the scientific terminology than with an honest explanation of what the scientific terminology meant.
Alone at my computer that night, I went to my trusted Harrison's Principles of Internal Medicine and translated the information into a 5-year survival rate of 24 to 29%. But it still wasn't what I was looking for. What I wanted to know, needed to know, was whether I should cancel the out-of-province electives that I had scheduled for the fall so that I wouldn't miss my father's death. What the chances were that my father would die while I was traveling across the country to interview for residency positions. Whether I was being foolish for thinking that my father might somehow survive to my medical school graduation in the spring. I needed someone with experience to put aside his or her discomfort and admit to me and my family that my dad probably had months, maybe only weeks. Without that information, I couldn't even begin to know how to navigate the horrible journey that lay ahead.
Unfortunately, despite the growing awareness of the personal side of medicine and the importance of effective communication, we as doctors are collectively awful at delivering bad news. Sitting with the oncologist that day was certainly not the last time I've witnessed a doctor be unable to admit that a patient is dying, or look at the floor while talking euphemistically about "passing away", or agree to help a patient with clearly incurable disease "fight this thing". And every time it happens it fills me with such sadness that the people that patients trust aren't able to be honest with them.
I know that it's hard. I've been the person delivering the bad news many times now, and I know how horrible it is, how painful the conversation. I know very well the temptation to paint a rosy picture even when it is abundantly clear that the outcome isn't going to be good. But I also know what it's like to be on the other end and how important it is to know the truth. So when I have to deliver bad news, I fight the temptation to sugar coat it, look my patients in the eye, and tell them with as much compassion and kindness as I can what their diagnosis means. Just like every doctor should.
A disclaimer of sorts: Because I'm blogging only semi-anonymously and anticipate that I may someday be identified by someone reading my blog, please note that any stories that I tell about patients or healthcare professionals are either composites or have identifying information removed to protect people's privacy. If my one of my Dad's oncologists were to ever find this blog, I hope that he or she will know that my family greatly appreciated what they did for my Dad and will recognize that this post is not in any way meant to be disrespectful or hurtful. It is simply meant to be an illustration, derived from personal experience, of the difficulty that doctors often have communicating with patients.