Talk­ing about ill­ness and dy­ing

Los Angeles Times - - OPINION -

Re “Art of break­ing bad news,” Opin­ion, June 27

Dr. Tom Roberts makes an im­por­tant point about the most dif­fi­cult med­i­cal con­ver­sa­tions, but these com­mu­ni­ca­tions aren’t al­ways about im­mi­nent death of a loved one.

I did my best to take care of my younger sis­ter and her battle with a par­tic­u­larly sin­is­ter form of de­men­tia. None of the many spe­cial­ists we vis­ited over the five years of her demise had the courage to tell me her ex­act di­ag­no­sis. The first time I heard of her spe­cific mal­ady was when I read it on her death cer­tifi­cate: Lewy Body De­men­tia.

Had I known about this rad­i­cal brain dis­ease, I could have re­searched and been bet­ter pre­pared for her and my fam­ily.

All med­i­cal prac­tices need to have some­one whose spe­cial re­spon­si­bil­ity it is to trans­late bad news. This per­son need not be a doc­tor, just some­one who has a gen­tle bear­ing and car­ing in­stincts. Mark Dressler San Juan Capis­trano

The sta­tis­tics Roberts cited are dis­heart­en­ing: Forty-two per­cent of med­i­cal school grad­u­ates were never taught how to talk to pa­tients about dy­ing, and 48% re­ported they never re­ceived feed­back on how they de­liver bad news.

End-of-life con­ver­sa­tions are dif­fi­cult in part be­cause they take time. They are more emo­tional than tech­ni­cal, and the in­for­ma­tion pro­vided can­not be vague and im­per­sonal. Physi­cians need to as­cer­tain pa­tients’ wishes so they can work to­gether to grant them.

This is as valid a part of the treat­ment plan as the treat­ment it­self. And it is sorely lack­ing. Deb Roth­schild Palm Desert

As my re­tire­ment from medicine nears, I find my­self wish­ing more than ever that I had saved a nickel for ev­ery time I’ve has to read the lat­est dis­cov­ery from a med­i­cal stu­dent or res­i­dent who must let us all know a Fun­da­men­tal Truth we have ne­glected as a pro­fes­sion.

In an op-ed ar­ti­cle that could serve as a clas­sic ex­am­ple of self par­ody,

Roberts uses a con­ver­sa­tion with a flus­tered nurse and the fact that a doc­tor checked his phone while talk­ing to let us know that his Stan­ford busi­ness pro­fes­sors do a much bet­ter job with “dif­fi­cult con­ver­sa­tions.” Sure, ex­cept that many of these con­ver­sa­tions in­volve fir­ing peo­ple or evic­tions or ex­plain­ing to re­porters that your com­pany wasn’t re­ally li­able for those pro­duc­tre­lated deaths.

In the fu­ture, Roberts can use his busi­ness school smarts to ex­plain why your co-pays are climb­ing, your MRI won’t be cov­ered, or why the doctors work­ing for him sud­denly felt they needed a new job. Richard Wil­liams, MD Sun­land

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