Last week the CBS show 60 Minutes featured a segment on end of life care. It covered a wide range of hospice issues.
- Doctors rarely talk to their patients about end of life issues
- Hospitalizations at the end of life are inordinately expensive (medicare incurs over half of its costs in the last few months of American’s lives)
- An excessive number of tests are run on patients at the end of their lives, i.e. scans, pap smears and blood analysis
- A lengthy hospital existence is demoralizing and dehumanizing
The host interviewed people who had recently lost loved ones. The patients had suffered through lengthy hospitalizations leading up to their deaths. A common theme was that doctors rarely speak to patients about their non-hospital, or non-aggressive options: hospice, palliative care, spiritual care, advanced directives, and dying at home instead of at a facility.
Speaking as a physician, I can say that this topic is one of the most difficult to discuss with a patient. I have heard some people say that the reason doctors don’t talk about it is because they are too busy, or they are not trained to do it, or the topic makes them too uncomfortable.
Those reasons are partially true. The main obstacle for me is that people react in varied ways, some appreciative and some quite angry. Essentially, I don’t know what to expect. I find it difficult to predict which person will react which way. In the worst cases, the patients and families leave the discussion with strong feelings of anger toward the doctor. The usual accusation is that the doctor has given up on the patient.
Nevertheless, we physicians must do better at entering into these discussions with our patients. The patients deserve our attention and advice. They deserve our acknowledgement of the spiritual nature of these discussions. They deserve to hear about hope, God’s reckless love for them, and life everlasting.
To ignore the truth about someone’s condition, carrying on with more tests and futile treatment, is, at worst, dishonest. And yet, the patients and families must be receptive to the discussion and to the reality that is in front of them. I like this poem by WH Auden:
Short in the leg and broad in the rump,
An endomorph with gentle hands
Who’ll never make absurd demands
That I abandon all my vices
Nor pull a long face in a crisis,
But with a twinkle in his eye
Will tell me that I have to die.