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September 22, 2000
Breaking the News

photo: J. Kevin Shushtari

Recently, my father died unexpectedly. I've been having a hard time accepting the fact that he is gone -- forever. Although I've delivered a lot of bad news to patients over the years, especially when I worked on a palliative care unit, I have not received much of it myself. When my father, a long-practicing cardiologist, received the news that he had terminal cancer, he approached the whole ordeal as if we, the family, were the patients and he were still the physician. I felt shock and confusion and then sadness and acceptance. I also finally began to experience what it meant to hear the words I had delivered so many times to patients and their families.

Years ago, when I was a medical student, I took a fourth-year elective in pulmonology (the study of the lungs and respiratory system), during which I worked with a young and brilliant doctor. A great medical teacher, a family man, and an athlete, this physician seemed to have a remarkable ability to balance his very busy life. Late one afternoon we went into a middle-aged woman's hospital room to give her the results of her bronchoscopy, a test to determine if she had cancerous tissue in her lungs. The patient made us wait while she put in her dentures, and the doctor repeatedly looked at his watch and fidgeted. "Well, it looks like you have the big C," he said as he stood at her bedside. "It probably doesn't make sense to quit smoking now because there's no cure. We'll have the social worker come around in the morning to arrange hospice." The woman looked up at us and flashed a quick, odd smile. "Gotta run to my son's birthday dinner," the doctor told her as we left the room. Flustered, the woman thanked us for stopping by.

A few years later, as a senior medical resident, I accompanied an elderly oncologist to inform a young man that he had lymphoma. This particular oncologist had a reputation as one of the most compassionate doctors on the medical staff, and I wanted to learn from him. He sat down at the patient's bedside and informed him that the results of his biopsy were complete. "You have something called lymphoma. It's a kind of cancer for which we have good treatment." The young man's eyes filled with tears, and the doctor instinctively reached out for his hand. "I'm going to see you through this, and together we're going to try to beat it. I will do everything within my power to help." At that point the patient's wife entered the room, and we spent more than an hour with them going over treatment options and the prognosis for recovery. As we left the room, the oncologist said, "Don't forget, Kevin, you need to be honest, but you can't take away hope."

I knew the pulmonologist was on the wrong track when it came to delivering bad news, and that the oncologist was on the right one. When I worked on the palliative care unit, what I learned from those two physicians was invaluable. I spent a lot of time studying how to deliver bad news and learned that I needed to be honest but kind, and that insufficient information from me would cause great anxiety in my patients. In my experience, people typically adjust to their diagnosis over time but often remain hopeful. As the physician, you are not only the messenger carrying the bad news; you are also the healer. The doctor's very presence at a patient's bedside offers the comfort that hope for life -- or at least a gentle end of life -- is not lost.

So, one final lesson from my father on how to be a better doctor. With me, he broke the news about his cancer gently, and he assured me that he had had a wonderful life. I was in England when he told me, and by the time I made it home to Rhode Island to see him, he had died. As a physician, he understood the psychology of grief and seemed to arrive at the acceptance stage earlier than the rest of the family. He died at home and worked at his profession until ten days before his death.

Related links:

Rx.magazine feature story: Palliative Care

 J. Kevin Shushtari, M.D., is's Chief Medical Officer and a co-founder of the company. He is also a board-certified internist with a medical degree from Dartmouth College. In Dr. Kevin's Column he will share his own experiences as a physician, a family member, and a patient.