The physician benefits from palliative medicine

It is hard to lie to patients who are dying.  To look a fellow human in the eye and tell them “everything will be OK,” is painful.  To give treatment that is unlikely to work is emotionally exhausting.  To watch someone die having never been honest causes burnout.

Denying the obvious spread of disease conflicts with what the patient perceives, and what the doctor knows. Even though the goal is to soften difficult news, the result of deception is isolation, confusion and suffering. This exacts a terrible toll on the doctor.  However, for many physicians it is not clear what to say or what to offer when therapy fails.  What has a physician to offer but false hope?

The only real choice for a physician is to tell the truth.    Physicians owe their patients complete information, and compassionate prognosis. The communication of realistic goals in terminal disease, takes patience, experience and compassion. Gently confirming that the disease is increasing and defining what is truly possible is to allow real comfort.  Setting achievable goals of life quality is a gift to the patient and family. Nonetheless, for doctors trained in diagnosis and cure, it may not be obvious how to transition to compassion and comfort.

In treating patients at the end of their lives, the physician benefits from palliative medicine.   Instead of the frustration of giving useless treatment and contrary advise, there is the satisfaction of a patient who feels better.  Instead of medicine that may not work, there is therapy to improve quality.  Instead of pulling patients away from their families, the doctor can help each patient share this important part of life.

The physician never has to desert his patient, but can maintain that vital relationship throughout each life.  Through honestly communicating and using the techniques of palliative care, a physician has the satisfaction of really helping.  In addition, the doctor knows that patients receiving quality “end-of-life” care, actually may live longer.

Hospice is good medicine for doctors.   They do not need to give the false “hope” of life forever.  The physician can always give true “Hope” that their patients will live with dignity and they will walk the path together.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

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  • itsonlypalliative

    i’m confused. your title is “The physician benefits from palliative medicine”

    #1 – you didn’t explain how they benefit
    #2 – ALL medicine is PALLIATIVE!!!!  there are no more cures because the money is in the treatment and the medicine, not in the cure!  so, what was the point of this blog?  if i missed something, please educate me

    • James C Salwitz

      Huh…obviously I failed to convey my thesis with needed clarity.  To whit – doctors are helped by the tools and concepts of hospice and palliative medicine because it gives them something to offer other then therapy which will fail and cause suffering.  HPM helps doctors even as it helps patients.  In the grand scheme of things we all die, therefore all medicine is “palliative” but my use of the term in this piece is centered on the formal field and concept of Palliative Medicine.

  • Iddlebiddle

    Love your article!  I believe there are two types of patients:  one
    wants to know everything including even the possibility of death within
    so many days or weeks and why further treatment may be more likely to
    fail than succeed.  The other wants to know nothing and to be reassured
    that everything will be OK until death.  

    I wish doctors would ask new patients which type they are and note it in
    their records so doctors would know how to address serious issues.

    I have had difficulty on occasion with doctors who believed I was one of
    those who wanted to be treated with kid gloves.  Because they didn’t
    know what to say, I was left standing there with no answers either way
    and that nearly drove me crazy!    Please docs, don’t be afraid to sock
    it to me!    I’m not the type who wants a doctor with a grand bedside
    manner.  I like the a smart, informed and caring, honest, polite, but
    blunt type like me.

    Patients like me are the types who were told at age 5 that there was no
    Santa Clause.  We don’t want to be forced into believing there is.  If
    our bodies are beyond repair, then tell us, but most of all, also tell
    us why.  We have already suspected that anyway and will respect you for
    your honesty.

    We also want your opinion about when we should start packing our bags
    for exit.  Even if you’re wrong regarding the timing, we want to hear it
    anyway.   In some cases, that opinion might be just enough to make us
    so defiant against having to leave this world early that we will rise
    from our death beds and literally walk away from death just to prove you
    wrong.  Even so, we will always respect you for your honest opinion.

    • James C Salwitz

      I guess that is part of the art of medicine….telling which patients want to hear the hard truth and which want the soft version.  In my experience, doctors tend to be too gentile.  Therefore, Palliative Medicine concepts and tools can help them to communicate and support their patients.

      • Debra Jarvis

        I think you mean “gentle,” not “gentile.”

        But thanks for the laugh!

        • James C Salwitz, MD

          It is after all Good Friday.

  • Joy

    this is a great article thanks

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