Teaching doctors to listen

I’m in favor of every medical school in the nation having a program like this one.

I can’t imagine how hard medical school must be, and am happy that God kept me from finding out. I also can’t imagine the pressure and stress that must come from having a person show up at your office, tell you what they think is going on with their body, and being expected to know what to do every time. It is a job that I don’t want and one that I’m thankful I don’t have. I say all of that because I feel unqualified to enter into a discussion about what should and should not be taught at medical school. That feeling isn’t going to stop me though.

If there is ever a time when a doctor needs to know how to listen, it would be when their patient has been diagnosed with a terminal illness. At any other time in the patient’s life, the doctor knows what the patient should do next. When the doctor is no longer trying to heal the patient, then the patient has to be in control again. How can the doctor know what to do next without knowing what the patient wants?

If you are going to help someone with a terminal illness, you have to know their goals. Do they want to – no matter what – die at home? Do they want to fight until their last breath? Are they willing to trade some of their precious time to ensure that the time they do have left is quality time (example: would they rather take chemo to slow tumor growth, be sick most every day of the rest of their life, and live for about a year – or – quit chemo, feel good for a month or so, and die within six months)? Is the patient’s only goal to walk his daughter down the aisle later this year even if that means that every day between now and then is lived in pain and discomfort? You don’t know what the patient wants until you ask the questions and listen to the answers. Yes, you probably know what you would want if it was you, but the truth is that it is not you so your opinion is no longer important. It is your patient’s life, so let them decide how it should be lived and help make that happen.

If we are going to improve how the dying are cared for in the United States, then one of the first steps must be training doctors to ask those questions and listen. I know that there are some great doctors, but I also know that they are outnumbered by doctors who either forgot why they went to med school or went for the wrong reason. It is my experience that most doctors don’t listen to their terminally ill patients, and it is my hope that more doctors will realize that there is a time when they should shut up and listen.

I could go on all day about the odd things that my patients have wanted, like the one who asked us to die her support hose hot pink because it made her feel young again. I could also go on all day about crazy things doctors have done when they didn’t get that a terminal illness is terminal, like the doctor who refused to order ibuprofen for a bone cancer patient because it has been shown to increase risk for heart attacks. (Hello, a heart attack would be the best thing that could happen to this guy!) In the end (and we’re talking about the end here) the doctor and the patient have to be on the same page. I’m all for doing all we can to teach doctors how to make that happen.

Sorry for the rant. There is a huge part of me that wants to delete this whole thing and act like I never wrote it, but the other part of me knows that this needs to be said. If I have offended you, then please stop and try to figure out if I really am a sorry self-righteous SOB or if you may just be the doctor that I’m talking about.