In the Health Section of this week’s Washington Post and in greater detail in the Narrative Matters portion of this month’s Health Affairs, Dr. Diane Meier, a noted expert in the field of palliative medicine and a professor of Geriatrics and Palliative Medicine at Mount Sinai in New York, writes about the role of palliative care in oncology. Dr. Meier uses one case example to illustrate the wishes of one of her patients, Jenny, to be able to anticipate and adjust to what comes next as she deals with a metastatic cancer diagnosis. Being a psychologist, Jenny was able to reason that communication with her oncologist about her need to talk about the eventuality of her dying was not going to happen. She was very happy with her oncologist, and considered their relationship to be a good one. But an essential element was missing, and that was an acknowledgement from her oncologist that she would likely die from her cancer. Jenny expressed her concern to Dr. Meier (whom she discovered during an internet search) that her oncologist would feel upset or hurt because Jenny had consulted Dr. Meier. With some trepidation, Dr. Meier became the conduit to communicate with Jenny’s oncologist and it becomes clear in both of Dr. Meiers’ narratives that Jenny and her oncologist were viewing the situation of Jenny’s poor prognosis and progression of disease very differently. Dr. Meier’s telling of this particular case has much to illustrate for all of us. The following conversation between Dr. Meier and Jenny’s oncologist tells us the underlying story when Dr. Meier asks the oncologist to help her understand his recommendation for some experimental treatment when Jenny’s disease is found in her brain.
Dr. Meier asked: “What are you hoping we can accomplish with this treatment?”
After a brief pause, he confessed what I suspected: that it wouldn’t help her.
I struggled for a response. “Would you want me to encourage her to go ahead with it anyway?” I asked.
After another pause, this one longer and more awkward than the last, he told me that he didn’t want her to think he was abandoning her. It seemed that giving more treatment was the only way the oncologist knew to express his care and commitment. To him, stopping treatment was akin to abandoning his patient. And yet the only sense in which she felt abandoned was in her oncologist’s unwillingness to talk with her about what would happen when treatment stopped working.
This article has much to advocate for—not only for well trained providers of palliative care but integral training in ALL medical schools for all physicians across all settings about truth telling to patients and the provision of palliative, humanistic, patient-centered care across all the transitions of life-limiting illnesses—from the moment of diagnosis and through one’s life.
Post by Ellen Stovall