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Author: Amy K. Chi

Medical Interviewing and the Doctor-Patient Relationship
Fall 2011
A. Chi, MD
Tufts University School of Medicine

Talking with the Terminally Ill and dying Patient

Introduction

The prospect of death strips away much that is unessential. Relationships, actions, feelings, all become imbued with a rare immediacy. It is the physician’s privilege to be part of this final stage in a person’s development. Frequently, it is that very intensity which causes us to shy away. Very few of us grow up with the guidance and opportunity to talk directly about death. When a doctor focuses solely on the medical aspects of the patient, the patient and their family can feel abandoned. By developing the ability to talk calmly, rationally and directly about death, you can be a tremendous source of support for your patients and their family.

Learning Objectives

By the end of the lecture, you will be able to:

  • Recognize the unique aspects of caring for the severely ill and dying patient.

  • Identify the need to engage with the dying as well as the family of patients who are dying and their caregivers.

  • Distinguish why it is difficult to do and ways in which doctors all too often avoid fully engaging with these patients.

  • Identify approaches to address the subject with all patients.

  • Explain the need to engage with the family of patients who are dying and their caregivers.

Specific competencies students are expected to perform within the context of practice after this lecture.

  1. Reflect with peers and section leaders on the self-knowledge to be gained in talking with all patients about death and dying.

  2. Talk with all patients about their thoughts and/or fears of death in a respectful and sensitive manner.

    1. Demonstrate kindness in dealing with the severely ill and dying patient and their family.

Recommended Readings

Remen, RN. Kitchen Table Wisdom: Stories That Heal. Riverhead Books, New York: 2006.