"Doctors, get your affairs in order!"

   "Doctors, get your affairs in order!"
       Screamed the op ed piece in the my favourite newspaper, The National Post.   Because I have spent much of my professional life training physicians, I read the article with considerable interest.
   The article was written by an unfortunate journalist whose wife died of a very aggressive malignant melanoma.  Treatment options were very limited and the tumour metastasized relentlessly to her brain.  The author was particularly outraged by the Radiation Specialist who they had never met before.  He came in to share the MRI results with him and his wife.  He gave it to them straight -a little too straight.  Unlike Drs in the past who often avoided the discomfort giving bad news always causes, by just not giving it, physicians understand nowadays that patients want and are entitled to the truth.  There is no way to make bad news sound like good news, but there is such a thing as beating the patient over the head with the truth.  Even the most unpleasant truth can be conveyed with compassion.  "Get your affairs in order is not such a message."  Such a statement is not necessarily arrogance, nor deliberate callousness.  It is often lack of communication skills in a technician who happens to be a health care specialist..   The specialist's opinion was that she had about four to six weeks to live without treatment, maybe three months with radiation to her brain.  After almost sixty years of medical practice, I know there is no way to make bad news sound like good news, but prognosticating in such a definitive fashion is often very inaccurate and decimates the sliver of hope a patient may be hanging on to.  A tiny bit of hope is better than none - and there is always a tiny bit of hope!        

   Patients recognize compassion when it is present and equally recognize its absence.  After delivering the catastrophic news, the physician added, "Get your affairs in order!"  The husband was enraged and insulted.  "Who are doctors to assume such arrogance to themselves?" was his retort.   He went on to say that the only affairs of his wife that were out of order were her medical affairs. 
   He was suffering greatly from a horrible, cruel, acutely painful and unreasonable situation.  Coming to grips with that sort of tragedy is inconceivable. But human beings in suffering, often feel that there must be someone or something responsible for their suffering.  We do look for somewhere to place the blame and often the doctor or nurse is handy. When the health care worker is less than skilled at communicating it compounds the problem.  It often makes them seem indifferent or even callous.  Not all people enjoy the gift of caring communication which in a health care worker is a particularly egregious problem.      The bereaved, in such circumstances cannot conceive of the physician or other health  care worker as being uncomfortable or even grieved and just not knowing how to convey the bad news to the unfortunate victim and/or their family.  Physicians used to be experts at communication with patients.  They spent hours listening, interpreting and explaining to patients the nature of their disorders, their significance, their management and the likely outcome in so far as they anticipated.  In other words Physicians and patients were at one with each other. They were on the same side. The relationship was not adversarial.  I never feared a legal suit because I knew most of my patients were on my side, just as I was on theirs.  There was no 'one complaint per patient', no ten minutes per visit, no 'appointment in six weeks', whether you needed it or not.  An annual 'complete physical examination', was a medium for the physician to become familiar with the patient as an individual and his individual complaints.  It was also an opportunity for the patient to get to know the physician and his/her approach and for them both to get the right match.  It was an indispensable component of thorough medical care, cost a pittance and we have allowed the administridiots to legislate it away. 
   All those things don't seem to matter any longer and we wonder why there is 'no service' anymore.  
   Perhaps it's time for the whole health care system to put its affairs in order!

   Comments welcome.