Recently the Seattle Times published an article about an Oregon physician’s own experience being diagnosed with a terminal illness.

The purpose of the article – and the purpose of Dr. Naito’s involvement, the doctor in question – was to shed light on the often “suboptimal” way doctors break grim news to patients. This is not an isolated incident, as an estimated 75% of patients in similar situations receive the bad news in such a “suboptimal” way.

In Dr. Naito’s case, he was able to piece together the news of his fatal diagnosis – stage 4 pancreatic cancer – from his own knowledge as a trained doctor, and snippets of conversations he would overhear outside the door of his clinic room.

That experience prompted Dr. Naito to devote a significant portion of what remained of his life to educating doctors on how they can improve the way they break such news to other patients.

This is not the only area in which doctors can be “suboptimal” in having a conversation with a patient. Certainly, when the doctor (or hospital) commits an error and causes harm, it is much easier to avoid any discussion about the cause of the unexpectedly bad outcome, or leave it to administration or lower level care providers to talk with the patient.

Similarly, a fatal diagnosis can be a subject that is very difficult to approach for doctors who perhaps have not had a lot of training in how to do it. One problem can be failing to take into account how emotionally overwhelming it must be for a patient to hear such news. Another problem can occur when doctors use medical jargon they are more familiar with, instead of plain language the patient will better understand.

This can be problematic, particularly when the patient is misled about her diagnosis, and makes health care decisions with incorrect assumptions. The article also cited a 2016 study that found that just 5% of cancer patients understood their prognoses well enough to make informed decisions about the medical care they wanted.

This may not ultimately change the outcome in a patient with a terminal disease, but it can certainly effect what treatment they get. For example, a patient may elect to undergo chemotherapy with serious side effects, thinking that it gives her a better chance for a cure than it really does. As a result, she suffer through the chemotherapy and side effects for a marginal increase in life expectancy. Had she known about the limited upside of the treatment, the patient may have elected to receive only palliative care, and enjoyed what was left of her life.

Dr. Naito is hopeful doctors will get better at having these difficult conversations, so that future patients will avoid the experience he had when he was “told” of his terminal illness. I imagine most doctors themselves would like to get better at it too.

You can read the Seattle Times article here:

[Oregon doctor with grim diagnosis is sharing a final message about how physicians break bad news](https://www.seattletimes.com/seattle-news/health/never-say-die-why-so-many-doctors-wont-break-bad-news/)