Coming to Medical School later in life brings with it a host of challenges and unique perspective. This week, we’re ‘learning’ how to break bad news to patients. This is an incredibly important skill for a physician and we were provided with numerous examples where patients were grateful for being given hope. It was also suggested that research on the importance of giving patients hope is pretty new. However, I couldn’t help but reflect on my Social Psychology research days based on Shelley Taylor’s work on Positive Illusions. Roughly 30 years ago, her work demonstrated that positive thinking is an adaptive behaviour that helps people cope with adverse situations, such as a cancer diagnosis. Furthermore, not only can this help people cope but these positive illusions are associated with better health outcomes.

I wondered why we were being introduced to the concept of giving patients hope as some relatively new idea. I thought about my own experience having the misfortune of being with both of my parents when they received cancer diagnoses (misfortune of the news, not being there), before I was in medical school and had any ‘training’ on how this was supposed to go. My mom’s surgeon did an excellent job, he spoke slowly, told her the result, gave her the best option (surgery), explained the biggest complication (pain management) and said “this is where many people say no thank you, but if you still feel like you have a lot of life to live. . .” before he even went on to the other options she was saying yes and we were arranging for next steps. I’d just met him but this horrible news was delivered with tremendous empathy and there was certainly no attempt to dissuade her from the best option given her age. As a side note, the surgery was successful, the pain was really bad afterwards, and she has thankfully been cancer free since then (knock on wood).

Then there was my dad. He went into the hospital with pneumonia nearly 3 years ago, and his intake form said ‘other than being sick, he’s a healthy 90 year old man’. However, when we got the call a few days after he’d been in the hospital that they needed to talk to someone about ‘his care’ – I knew it wasn’t going to be good news. The doctor came in, sat down and said to my dad:

We’ve found untreatable cancer in your stomach and liver, and you’re no spring chicken you know. . .

At this point, we were likely both in shock, and my dad – to his credit – said “well that’s the way she goes I guess.” I could see the tears forming in his eyes while I tried to hold mine back and remain strong for him. He then went on to tell the doctor he didn’t want to be hooked up to any machines, and confirmed I knew this about him. I stepped into the hallway with the doctor asking how long she thought he had. She told me she didn’t think it would be long, maybe a few months, maybe he’d make it until Christmas (it was November), then the tears started to flow. She told me it sucked no matter how it happened, that she had lost one parent quickly and one that took a long time and that either way, it sucks (I’m sure she’s not wrong about that).

At the time, I felt she was both nice and supportive as a doctor neither of us had known before. However, this week – I couldn’t help but wonder if that news could have been delivered differently, in a way that gave my dad more hope. I believe my dad made peace with what he was told in that moment and chose then to check out as quickly as possible once he’d knocked a few things off of his list. We got him out of the hospital within days, which was no small feat, and watched his health decline every day. He had one good last weekend at home visiting with family, making phone calls, and giving people to-do’s. It was just 13 days from the day we got the diagnosis to when he passed. Maybe that’s what was best for him; he did get time to say good-byes without it being a long drawn out decline so for that I think we were all grateful. However, selfishly now – I can’t help but wonder if maybe we could have had a few more good weeks, or a scenario where he did make to Christmas. In any case, both of these experiences have made me reflect a lot on how I want to break bad news to patients.

As a side note, here’s a link to some of the research I did with Tara MacDonald, PhD on how mood and how it can affect decisions related to health.