I recently spoke with two physicians about what patients understand the words “treatable” and “incurable” to mean. Drs. John Hearst and Carol Tunney were interviewing me for their radio show, “Natural Instincts,”which is about “Health, Healing and Conscious Living.” The main subject of the hour was our new initiative—this website, SpeakSooner.org—and the challenge of improving communication between doctors and patients.
At some point the conversation turned to how physicians break the news to patients that their illness cannot be cured.
Dr. Hearst acknowledged, “We give the good news first, which is that it’s treatable. But we don’t give the bad news [first] that it’s not curable.”
I asked him, “If you change the order of the words—saying, it’s not curable but it is treatable—does that send a different message?”
Dr. Tunney was quick to respond. “Just sitting here, I felt a visceral reaction to [hearing] ‘it’s not curable but we can treat it,’” she said. “All I really hear is ‘it’s not curable.’ But if you tell me it’s ‘treatable’ I am open to hear more.”
These doctors’ reasoning makes sense. But perhaps they do not realize that patients’ experiences may be shaped by a different understanding of terms that for doctors feel very familiar. This realization came to me in my work as a medical humanist, when a patient told me she understood “treatable” to mean “both curable and life extending.” It was not clear to her that treatment—those trials that offer promise—may not alter the course of her disease.
What do you understand “treatable” and “not curable” to mean? Which one would you want to hear first?