Learning about death and dying in residency is perhaps one of the hardest things about being a doctor. ... This list might make it a tiny bit easier.
1. The Hippocratic oath challenges us to be teachers not only to students, but also to our patients – especially to our dying patients. Remember you are teachers.
2. Nurses spend the most time with your patients; utilize them and learn from them. Nurses will make you better teachers and physicians.
3. When a patient is dying, hold that person’s hand if family isn’t around. Touch your patient.
4. Accompany your residents, fellows, or attending physicians to deliver bad news.
5. Ask to debrief after a patient dies.
Dr. Lexy Morvant
6. While discussing treatment or prognosis with families, pay attention to the emotional data in the room. Tears should prompt tissues or hand holding. A wrinkled forehead or fearful face warrants a pause in conversation for the family to absorb the content. Tears don’t mean to hurry.
7. Attempt to understand your patient’s expectations. In other words, learn what the family’s goals are for treatment.
8. When a patient dies, reflect upon it in moderation. Don’t just move on to the next task. It’s okay to feel and to grieve … you are human.
9. When families declare DNR [do not resuscitate], don’t ask them repeatedly if they are sure. Also, make certain that they know they can change their minds at any time. Respect a patient’s values and wishes.
10. Take the time to have the difficult conversations early in diagnosis so families know what to expect. This empowers decisions that are proactive as opposed to reactive. Be proactive in your role as a teacher.
11. When discussing options, talk about what you CAN do before you talk about what you CAN’T do.
12. Withdrawing treatment and forgoing treatment are the same thing ethically and legally, but not emotionally.
13. When your patient is actively dying, see it out. Stay with the family, even if it’s time to go home.
14. When the family prays, be present.
15. Palliative care is neither hospice nor social work.
16. Ask your dying patients if they are afraid of anything – if the moment presents itself. Answer questions about death or find someone who can answer their questions.
17. No patient should die in pain. The doctrine of double effect allows a caregiver to provide medication for pain even though it may hasten death.
18. For the dying child, ask the family where they want their child to die. Don’t assume the family wants the death of their child to be at home or in the hospital. Ask.
19. Transitioning from treatment-oriented management to comfort care does not ever mean “there is nothing we can do.”
20. Lastly, and most importantly, I leave you with a question that should be in the back of our minds regarding quality of life and treatment options: Just because we can, should we?
Dr. Morvant is a second-year pediatric resident at Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tenn. E-mail her at pdnews@frontlinemedcom.com.