Tuesday, November 18, 2008

White Coat, Black Art...

I was driving back from the hospital on Saturday and my attention was caught by the program 'White Coat, Black Art' on CBC. The topic was 'Physician Lies', and I had to admit to myself that I have lied to patients. I found the program interesting for the fact that the guest Brian Goldman was interviewing was referring to Hippocrates and stating that the ancients had said that patients were only entitled to the truth when it was beneficial to their treatment. I think that is a gray zone in medicine that deserves some debate, however, it's another part of that program that spurred me to write this post...

Dr. Goldman made a comment about residents and the discussion of end-of-life care with patients. I think that he did a disservice to residents in his sweeping generalization. He referred to the tone and content of these discussions as 'brutal'. I think that some background is required in that debate, and talking about that subject in the context of a show on 'medical lies' is not appropriate. I'm sending this post to him to let him know that his comments really offended me.

First, I want to acknowledge that death is still a taboo subject in our culture. I don't think that many feel comfortable talking about the end of life or what they would like done if their heart were to stop. This is not dissimilar to the way that cancer was a taboo subject (evidenced by Susan Sonntag's 1977 book 'Illness as Metaphor'). As with cancer though, we need to move beyond this prudish fear of an important subject.

I want to keep this rant short. The foil that I want to create is thinking about an aging loved one sitting in their home at an intimate family event, fully aware of surroundings and healthy. The second image is that of a family member in the intensive care unit, unable to communicate due to the breathing tube in their throat, countless tubes running this way and that. An unknown physician asking you to decide whether to continue providing respiratory support to keep them alive.

I've been in the position of the provider, talking to wide-eyed families. It's obvious who has had the conversation of end-of-life decision-making with family.

Dr. Goldman, I had a discussion with 2 patients this weekend regarding this subject. I was HONEST about what to expect should a code blue be called...I was sensitive, but firm in by recommendation that the subject of end-of-life decisions should be discussed. I'm not perfect at talking to families about this, I know that I cause some pain...but I also make sure that the patient's wishes are respected, either on their current admission, or in the future...and that's what matters to me.

I hope you realize how your insensitive comments sounded on national radio. They did a disservice to medical trainees everywhere.

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