Today, The Cheerful Oncologist reminded me why he was one of my role models when I first started blogging, as he takes on the issue of palliative care:
As often as rain falls from the skies do patients reach that point in their illness where their doctor says "There is nothing more I can do for you."
If you ever hear that phrase, remember this: it is a lie. Physicians who tell their patients this may actually mean "I'm getting depressed watching you die and want to avoid you," or they may think of illness as a contest of skill where only victory has any value, and defeat must be acknowledged by immediate sacrifice of the vanquished.
If there is one single area where conventional medicine does not live up to its capabilities, it's in the area of palliative care in cancer or other deadly diseases after known curative treatment has been exhausted. Perhaps if more doctors learned better palliative care, fewer patients would feel abandoned by conventional medicine and thus fewer would be susceptible to the siren call of quackery.
There has to be a good alternative that communicates this.
Something like, "there is nothing more we can do to fight this disease", or "we have no treatments that will cure you, but we can make you comfortable." What do you say?
It's especially bad when it's interpreted to mean "there's nothing else anyone can do for you."
I know the med school I work for has a required multi-week palliative care seminar as part of the internal medicine clerkship for third-year students. It's probably woefully inadequate in the grand scheme of things, but at least it's something.
Its sad that the phrase still lives on. It is a stark demonstration that provider-centered care rather than patient-centered care leaves much to be desired in quality or mindfulness. The patient-centered team approach in hospice care, or the Alaska Native American system now beginning to make national exposure, would quash folks trying to make such utterances.
This phrase may say more than intended - "You need a doctor who knows how to care for you, and I can't/won't."
Not just with deadly diseases. Doctors seem willing to give up on chronic pain cases, just for instance; my husband had 2 tell him that his pain was as under control as they could get it butt he good news was his arms would continue aching another 50 years or more before he might die. (Great, get your patients to consider suicide as the only 'cure; for their pain.) A biofeedback specialist told him he'd done all *he* could, but referred the Mr. to a rhumatologist who does pain management for fibromylagia. An injection of a numbing agent every two months breaks the cycle of tension and allows the pain to subside. But it was emotional as well as physical agony seeking some hope for care.
There's always something someone can do to improve the situation, however slightly.
I was told, after receiving a pitocin drip for about 2 or 3 hours, right AFTER they ruptured the amniotic sac (and pitocin or rupture alone is fine, the combination is hellish, and I've had it both ways, one for each pregnancy, so I know of what I speak), that I couldn't have an epidural because my platelet count was too low. The anesthesiologist apologized and said that when it came time to deliver, he would do everything he could to make me more comfortable.
And there was a point during the delivery when all he COULD do was stand there and let me squeeze his hand as hard as I wanted -- and that did make a difference. Maybe only a small one, but it was a difference. And I am grateful to him for that to this day.