Communicating With Terminal Patients: Lessons from Wit
Emma Thompson said it loud; health professionals need to know how to
deal with terminal patients (TP). Right she is. In our medical school,
students may receive their doctor degree without observing or telling
someone that s/he has terminal illness. This major deficiency results in a
feeling of unease on the side of the physician when looking after TP.
Moreover, TP may have an undignified death at a high cost to families and
the society. To light a candle instead of cursing the darkness, our
department started this academic year a session that highlights the
principles of communicating with TP. This 2- hour session is given to last
year medical students. Here I like to share with you the content of this
intervention and report preliminary feedback given by the students who
attended this session till now.
The movie Wit made it easier to prepare for this session, which starts by an
around twenty minutes interactive power point presentation. Sixty-four
minutes clips from the picture Wit follow this. Students were asked to
comment every 8-15 minutes on what they have watched. At the end they
filled an evaluation form.
What can we learn from Wit? We can review many principles of dealing
with terminal patients that were raised in the BMJ 2003, July 26th issue.
Let me start by the "unreasonable" restrictions mentioned by Gatrad
et al (1). Besides limiting the hours of visiting and the number of
visitors, a person should be moved by a wheel chair even if she can walk
freely.
When it comes to feelings, physicians express interest in the case-
not the patient. They say excellent when the patient tolerates the full
dose that results in shrinkage of the tumor but agony and death to the
patient. When asked if he misses his patients the resident smiles. When
the terminal patient asks what the young doctor, who scored A minus in a
literature course, says when patients are apprehensive and frightened, he
answers: of whom?
Doctors often fail to provide patient -centered care. Dr Dingle
Spence respected a tramp's wish and allowed him to die peacefully under a
bridge from lung caner with the help of a palliative care team (2).
Unfortunately, the heroine of Wit, who is a professor, was not counseled
about end of life issues and was not given the right for patient
controlled analgesia in a teaching hospital! It was Suzy, the nurse, who
does not know a lot about literature and poetry who empowered the patient
with knowledge and by listening.
We physicians many times impose what we think without seeing or
hearing the facts. Our ego does not allow us to listen- not only to
patients but also to health team members-the nurses. We ask the patient
how are you doing when she is moaning from pain. The full dose of
chemotherapy should be given in spite of all side effects and
complications.
Our great fear of death creates anxiety that blinds TP and us. This
results in poor plans for death. As shown by Glare et al and others, we
usually overestimate survival of TP (3,4). One single patient with colon
cancer did not consider writing a will because his oncologist gave him a
rosy picture. As a result his beloved inheritors had major financial
difficulties. Yes we should ask forgiveness for we have sinned. Myself did
not visit a dying colleague who selected me as his family physician to
avoid seeing him suffering. A brother of a colleague was dying from
advanced melanoma, when she asked the treating physician not to intubate
him if he arrests, the answer was: you want to kill him? In general TP are
not afraid from death but are terrified from the absence of their beloved
ones and the caregivers when they need us. True, it is all about dying and
not death. Emma Thompson asked the nurse- not the prolific researchers, if
she will be around when the time comes. She wanted to make sure that
somebody would let her heart stops.
At the beginning I was anxious about students getting bored by this
long session. This was replaced with a feeling of triumph when I looked at
their feedback. The session was highly rated and one wrote "one of the
most excellent sessions that I have taken in medical school". Others asked
for more time for this topic.
The use of clips from the movie Wit may turn to be a powerful method
of teaching medical students principles of dealing with terminal patients.
If you ever go by this recommendation let me know your feedback.
References
1. Gatrad AR, Brown E, Sheikh A. Palliative care needs of minorities.
BMJ 2003;327:176-177.
2. Yamey G. Building hope. BMJ 2003;327:s30.
3. Saunders Y, Ross JR, Riley J. Planning for a good death: responding to
unexpected events. BMJ 2003;327:204-206.
4. Glare P, Virk K, Jones M, Hudson M, Eychmuller S, Simes J, Christakis
N. A systemic review of physicians' survuval predictors in terminally ill
cancer patients. BMJ 2003;327:195-0.
Rapid Response:
Communicating With Terminal Patients: Lessons from Wit
Emma Thompson said it loud; health professionals need to know how to
deal with terminal patients (TP). Right she is. In our medical school,
students may receive their doctor degree without observing or telling
someone that s/he has terminal illness. This major deficiency results in a
feeling of unease on the side of the physician when looking after TP.
Moreover, TP may have an undignified death at a high cost to families and
the society. To light a candle instead of cursing the darkness, our
department started this academic year a session that highlights the
principles of communicating with TP. This 2- hour session is given to last
year medical students. Here I like to share with you the content of this
intervention and report preliminary feedback given by the students who
attended this session till now.
The movie Wit made it easier to prepare for this session, which starts by an
around twenty minutes interactive power point presentation. Sixty-four
minutes clips from the picture Wit follow this. Students were asked to
comment every 8-15 minutes on what they have watched. At the end they
filled an evaluation form.
What can we learn from Wit? We can review many principles of dealing
with terminal patients that were raised in the BMJ 2003, July 26th issue.
Let me start by the "unreasonable" restrictions mentioned by Gatrad
et al (1). Besides limiting the hours of visiting and the number of
visitors, a person should be moved by a wheel chair even if she can walk
freely.
When it comes to feelings, physicians express interest in the case-
not the patient. They say excellent when the patient tolerates the full
dose that results in shrinkage of the tumor but agony and death to the
patient. When asked if he misses his patients the resident smiles. When
the terminal patient asks what the young doctor, who scored A minus in a
literature course, says when patients are apprehensive and frightened, he
answers: of whom?
Doctors often fail to provide patient -centered care. Dr Dingle
Spence respected a tramp's wish and allowed him to die peacefully under a
bridge from lung caner with the help of a palliative care team (2).
Unfortunately, the heroine of Wit, who is a professor, was not counseled
about end of life issues and was not given the right for patient
controlled analgesia in a teaching hospital! It was Suzy, the nurse, who
does not know a lot about literature and poetry who empowered the patient
with knowledge and by listening.
We physicians many times impose what we think without seeing or
hearing the facts. Our ego does not allow us to listen- not only to
patients but also to health team members-the nurses. We ask the patient
how are you doing when she is moaning from pain. The full dose of
chemotherapy should be given in spite of all side effects and
complications.
Our great fear of death creates anxiety that blinds TP and us. This
results in poor plans for death. As shown by Glare et al and others, we
usually overestimate survival of TP (3,4). One single patient with colon
cancer did not consider writing a will because his oncologist gave him a
rosy picture. As a result his beloved inheritors had major financial
difficulties. Yes we should ask forgiveness for we have sinned. Myself did
not visit a dying colleague who selected me as his family physician to
avoid seeing him suffering. A brother of a colleague was dying from
advanced melanoma, when she asked the treating physician not to intubate
him if he arrests, the answer was: you want to kill him? In general TP are
not afraid from death but are terrified from the absence of their beloved
ones and the caregivers when they need us. True, it is all about dying and
not death. Emma Thompson asked the nurse- not the prolific researchers, if
she will be around when the time comes. She wanted to make sure that
somebody would let her heart stops.
At the beginning I was anxious about students getting bored by this
long session. This was replaced with a feeling of triumph when I looked at
their feedback. The session was highly rated and one wrote "one of the
most excellent sessions that I have taken in medical school". Others asked
for more time for this topic.
The use of clips from the movie Wit may turn to be a powerful method
of teaching medical students principles of dealing with terminal patients.
If you ever go by this recommendation let me know your feedback.
References
1. Gatrad AR, Brown E, Sheikh A. Palliative care needs of minorities.
BMJ 2003;327:176-177.
2. Yamey G. Building hope. BMJ 2003;327:s30.
3. Saunders Y, Ross JR, Riley J. Planning for a good death: responding to
unexpected events. BMJ 2003;327:204-206.
4. Glare P, Virk K, Jones M, Hudson M, Eychmuller S, Simes J, Christakis
N. A systemic review of physicians' survuval predictors in terminally ill
cancer patients. BMJ 2003;327:195-0.
Competing interests:
None declared
Competing interests: No competing interests