How Doctors Communicate Terminal Diagnosis: A Personal Insight

Deciding to share a terminal diagnosis with a patient and their family is a delicate and often challenging task for healthcare professionals. The approach that doctors take can vary significantly based on their years of experience and training. In this article, I share a personal account that highlights the nuanced differences in how doctors communicate such sensitive information.

Younger Doctors vs. More Experienced Doctors

My sister-in-law's (SIL) mother's journey to a terminal diagnosis of cancer serves as an illustration of these differences. Younger doctors, typically those with less experience, are often more sensitive to the emotional impact on the patient and family. They aim to be gentle in their delivery, recognizing that the patient and their loved ones may not be ready to hear such news, even if the prognosis is grim.

The Case of SIL's Mother

SIL's mother, who had previously been diagnosed with type 2 diabetes and had undergone significant weight loss, began experiencing ongoing stomach problems, severe weight loss, nausea, and alternating constipation and diarrhea in 2022. Despite these symptoms, her primary care physician (GP) initially diagnosed her with diverticulitis and suggested keeping a food diary to identify trigger foods.

Seeking a Second Opinion

My sister-in-law, being trained in the medical field, often sought my advice. However, it was always reiterated that the GP was the best person to follow up on these symptoms and that any further diagnosis would need to be pursued within the healthcare system. This practice is common and serves to ensure patients receive appropriate initial care and guidance.

Severe Symptoms and an ER Visit

The situation worsened when the symptoms included severe cramps and pains, followed by nausea on a daily basis, and back pain. The pain became so excruciating that they eventually sought care at the emergency department (AE) by ambulance in early October. Here, despite seeing various doctors, the diagnosis of cancer on the pancreas was not immediately clear. It wasn't until a CT scan was performed that the severity became apparent, with a large mass on the pancreas indicating stage 4 cancer.

The Communication of a Terminal Diagnosis

The patient's impact on the doctor's approach cannot be understated. While younger doctors were more compassionate and sensitive, the senior doctors at the emergency department were practical and blunt. The young doctor, around the age of 27, suggested a CT scan, which indeed showed the pancreatic mass. She then brought in a more senior doctor, an on-duty oncology specialist, to deliver the news.

Adult Emergency (AE) Specialist's Approach

The senior doctor delivered the devastating news concisely and without unnecessary euphemisms. "It's cancer, there's nothing we can do. You probably have about 6 to 8 weeks left," he said before turning to leave. The junior doctor tried to soften the blow by offering palliative care and pain management for the last few weeks of life. He also provided contact details for Macmillan Nurses and local hospices for further support.

A Self-Protection Mechanism?

Reflecting on this interaction, I wondered whether the senior doctor's blunt approach could be a form of self-protection, shielding him from emotional pain by hardening himself emotionally. However, this job does require exceptional compassion and empathy. Doctors who deal with death daily must remember that they are not just sharing information; they are speaking to individuals and their families who are facing unimaginable uncertainty and fear.

Compassion in Healthcare

It is a reality in healthcare that doctors encounter terminal diagnoses regularly. Balancing the medical facts with the emotional and psychological needs of the patient and their loved ones is a challenging task. Each healthcare professional approaches this responsibility differently, but the overarching goal is to provide the best possible care in a compassionate manner.

Understanding the nuances in how doctors communicate terminal diagnoses and the emotional impact on both the patient and family is crucial for improving healthcare practices and patient care. If you or someone you know is facing this situation, seeking support from palliative care teams and counseling can be invaluable.

By exploring these topics, we can foster a deeper understanding of the challenges faced by healthcare professionals and the range of emotions experienced by patients and families in such trying times.