The Hippocratic Oath states “I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.” Yet, sometimes doing good for your patients can come with harm. Treatments could very well have unfavorable consequences. As long as the benefits outweigh the costs, the patient should come out ahead. But, what if the patient has a terminal illness? This week we covered the pancreas, which comes with the inevitable discussion of pancreatic cancer. Pancreatic cancer may not be one of the most common cancers, yet it is considered to be infamous because there is very little for the doctor to do in most situations. It was this week that we practiced giving the worst possible news you could give to someone: they are dying and there is no changing that.
An old woman had just come from surgery, and it was discovered that her pancreatic cancer had metastasized. This is considered a death sentence in the medical world. When telling patients about their terminal illness, using the right words and phrases is very important. “You are dying” or “you are going to die” doesn’t do the patient any good. The doctor needs to be honest AND sensitive, not overly blunt. People like to use the phrase “pass away,” which I prefer. Saying we lost someone is an awkward misnomer. But we do whatever we can to make the event less painful. The focus of the discussion was around the patient’s remaining time and palliative care. This leads to the topic of hospice. Our patient’s main concern was her excruciating pain. Treating her pain and halting the treatment of her disease was now the focus for her remaining time. Our patient’s goals had changed after hearing her prognosis. Instead of curing her disease, she wanted to reach peace before her passing.
Some may say this is medicine’s way of giving up. Some patients want to die with dignity and feel that being pain free is paramount. Treating a terminal disease until the patient cannot take it anymore can be seen as futile and an improper use of resources. Of course the decision is left to the patient. The earlier the doctor is able to talk with the patient about their prognosis, the more time they have to get their affairs in order. We all know we are not long for this world, but sometimes addressing that fact by writing a will or buying a grave plot makes the idea more real than we want it to be. Even the doctor may not believe it is real, hence their hesitation to have this serious discussion with the patient. Giving the news of a terminal illness needs to be done right so by the end, the patient is left with no more wrongs.