Improving Education 289
Increasingly, they saw the delivery of such medical information as a‘‘ talent,’’ especially since many patients misunderstood and‘‘ twisted’’ what they heard. This task took dedication. Neil, the neurologist, commented:
Information is good, as long as it’ s delivered in a way the patient can understand. But many doctors don’ t have that talent, so it’ s useless. Some patients take a little information and misunderstand.
As a result, Neil tried to be as careful as possible,‘‘ to be gentle when I give bad news.’’
Many became more sensitive to communication about difficult decisions concerning death and dying, and to addressing these areas in a more sensitive and timely manner. Jennifer said that after her diagnosis, with patients,‘‘ I talked a lot more about end-of-life issues and resolving things and being very open and up front about it.’’ She suggested, though, that despite her relative openness about many clinical matters, death and dying remained difficult topics for her.
Even physicians who felt they were sensitive to end-of-life issues to begin with nonetheless changed. Mathilde described the heightened attention she gave to these topics after her husband’ s death.
Now, I put myself in my patients’ clothes. When I talk to them, I really talk to myself: How would I react to what was being said? If people used my words toward me, would I consider them too blunt? If I ever had any rough edges, I smoothed them.
Mathilde suggested the aesthetic considerations in such discussions: avoiding either bluntness or‘‘ roughness,’’ trying to smooth transitions, and perhaps softening information— or at least its impact.
Many physicians altered how they discussed not only death, but also poor medical outcomes. Following the loss of her husband, Mathilde became even more sympathetic than she had been before toward framing as positively as possible other major changes in patients’ lives.
My husband’ s illness led me to have even more sympathy than I ever expressed. When I had to tell patients that their kidneys had failed, and that they had to go on dialysis, I would say,‘‘ I don’ t tell you: you have to die. I tell you that you’ re going to have another life. It’ s different and difficult, but you are going to live.’’ I’ d use my husband’ s example, if they knew him:‘‘ I wish his doctor had said the same thing. I’ m not saying you’ re lucky, but within the