Doctors and End of Life care – Bridging the Gap




I was seeing this movie on a lazy weekday evening. The Bucket list. It stars two of my favourite actors – Morgan Freeman and Jack Nicholson of the “You cant handle the truth” fame. And in the movie, it is depicted how these two gentlemen are facing the cold hard truth that they are going to die in a few months from their cancers. And these men then decide to do the things that they want to really do before they say the final Hurrah.

Though the movie was engaging and bit of a tear jerker and goes on to give out a quite a lot of life lessons. But as a Urologist dealing with end of life patients and as Physician faced with giving news to family and friends about sick patients, I was particularly concerned with the way the doctor in the movie was depicted handling these two gentlemen.

Though his behaviour was particularly disgusting, but I made me think about myself. And true to the movie, I realised that I do behave similarly with my patients many times. Knowingly or unknowingly. (It is counter intuitive for my publicity to talk negative about myself, but I realise “OPEN NESS” is the first step to acceptance and I owe it to my patients to self introspect and provide better care to them). In one scene, Morgan Freemen or “Carter” asks the busy busy doctor to take a look at him, and the doctor just brushes him aside. Though the query was small and insignificant for the physician and he may have handled a million such queries before, but I feel now that by sparing a minute for Carter, the doctor could have won the confidence of the patient. And he didnt win his trust again ever throughout the movie.

But is it the doctors job to win his patients trust. Isn’t he there to cure them?  Yes he is. Yes I am there to cure my patients, but then the truth of the matter is that when you deal with cancer and specially Urological cancers, cure may not always be possible. So then do I brush aside my responsibility and pass it on to the nursing staff and family and move on. Or is it my duty to provide that shoulder for my patients to lean on be that reassuring hand on their backs as they take their last steps. But, then I think that in my busy schedule, if i provide all my patients with this kind of support, not only will i be emotionally drained but I wont have the energy to treat those who still have a chance.

But, I do not think that patients expect their doctors to be counsel and guides and philosophers. I think in my experience most patients usually accept their diagnosis and prognosis beautifully. They are old, have lived fulfilling lives, many will have excellent support systems (thank goodness for the Indian culture) and know what is expected to move on. I think what they expect from their doctors is

  • Truth and the complete truth – I think being brutally honest is essential. About the disease, stage, options and time. I think by dilly dallying, giving false hope we as physicians are doing a great disservice to out patients. Accurate knowledge allows the patients family and friends to be prepared. it allows them to move through the stages of acceptance better.
  • Closure – I think as Doctors by saying that if they came sooner, we put the onus of the patients death on them. I think we should stress that they did everything right, that this one belonged to god.
  • Empathy – I think patients do not want sympathy. They do not want our tears. But understanding their problems and making things easier such as scheduling chemo, easing paper work and listening patiently to their queries (even if we have no solution) can go a long way

I feel this can provide comfort and ease a patients nearing the end some trouble. What do you think? let me know.

I am also opening this topic in the forum for discussion.

Another day another topic to write on

Stay strong Live well.

Bye and good night.


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