As a medical humanist, I think about barriers and solutions to effective communication between patients and healthcare providers. We understand that patients facing serious illness are frightened and overwhelmed by an uncertain future, no less entering a world that speaks a foreign language. It is not unusual for patients to be silent as they try to absorb what is happening to them. On the other hand, medical professionals, who have taken an oath to do no harm, often find themselves weighing how and when to deliver bad news about a failed treatment or a poor prognosis. With this in mind it’s not surprising that conversations about health status and viable options for treating incurable illness are uncomfortable for both patients and healthcare providers and, as a result, are frequently postponed. However, it is important to recognize that avoiding difficult conversations can have profound and lasting consequences.
When I recently learned of a study that indicated oncologists tend to overestimate a patient’s life-expectancy at 5 times longer than what statistics showed, it stopped me in my tracks. Breaking bad news will never be easy nor will hearing it. And, there’s no doubt that it’s hard telling patients that further treatments would be futile and their time is limited. But stop and think about how avoidance of these conversations could result in unnecessary suffering from continued debilitating treatments, leading to regrets for patients and loved ones who believed they had more time than was realistic.
I recall meeting with a patient who had been told a poor prognosis. He asked, “How do I live knowing I’m going to die?” I’ve often heard people use the familiar refrain of “live one day at a time.” But, having a longstanding relationship with this patient, I risked sharing the wisdom of my 83- year old mother and said, “Don’t buy green bananas.” The patient smiled as he grasped the meaning of those words.
I’m not being flippant by referring to my mother’s words or suggesting that doctors use a “green banana” analogy. What I am saying is that patients have a right to know what they are facing so they can make plans that are meaningful to them based upon their values and priorities. This would allow for setting realistic goals for the time they have. As uncomfortable as it may be, patients need to inform healthcare providers sooner in the course of illness that they want open and honest disclosure about their condition and prognosis. The stakes are too high. If healthcare providers hide behind their discomfort, even if they believe that they are doing no harm by withholding truthful prognostic information, patients and their loved ones are likely to suffer unnecessarily.