Dr. Wendy Harpham is a doctor of internal medicine, cancer survivor, and award-winning and best-selling author of books about cancer: Healthy Survivorship, recovery and late effects, and raising children when a parent has cancer. She is also a public speaker, patient advocate, and mother of three.
Today let's look at her husband's view of the article. Robert Pardi's comments were posted on Pallimed to enrich -- or shall I say, to straighten out -- the discussion about his wife's decision. Although he doesn't use the term, he's telling us his wife was a Healthy Survivor.
In my April 6th post I discuss the case of Dr. Pardi, a palliative care physician who chose to continue aggressive cancer therapy when she was dying. Letters to the editor about the article don't mention what I consider to be a key point.
Discussions about end-of-life can benefit patients and their families in dramatic ways. Unfortunately, the emotional discomforts for both physicians and patients often serve as insurmountable obstacles to initiating these important discussions.
On January 26th I blogged about the risk of patients being accidentally injured by overdoses of therapeutic radiation therapy. I brought it up for many reasons, one of which was to lead into a post of mantras for dealing with bad news. Another was to point out that "bad" news can lead to good news.
Healthy Survivors use language that helps them get good care and live as fully as possible. In the case of challenges, it is usually better to say "very" instead of "too." For example, "This newspaper article is toovery upsetting."
What if a topic really is "too" upsetting? What's a Healthy Survivor to do?
In last week's Science section of the NYTimes, Denise Grady reported on a recent study in which most of the doctors who responded to a survery indicated they would wait until their terminally ill patients felt worse or were out of options before talking about end-of-life care, such as hospice.
I was moved to write a letter to the editor (p.D4 or click here) when I read one of the possible reasons cited: fear that patients will lose hope or that physicians will “yank away” hope by talking about end-of-life wishes.
When patients with serious diseases are being cared for expectantly, they often scoff at the standard medical discriptors: "Watch and Wait" or "Wait and See." For them, a phrase that better captures the experience is "Watch and Worry" or "Worry and See," circumstances not conducive to Healthy Survivorship.
Facing Facts, At Least Briefly generated some discussion about patients who don't want to know if they are dying because they don't want to ruin their quality of life. This leads to a more general quandary: What if getting good care makes it impossible to live fully, and what if living fully makes it impossible to get good care?
Right or Wrong? extols the benefits of good communication between doctors and patients. But what if a patient makes the request, "Doctor, if a time comes that I'm dying, please don't tell me I'm dying."
It seems a reasonable request, if knowing "would only increase my anxiety and make it impossible for me to hope for future better days," as described in the post's comments by Bint Alshamsa.
When something goes wrong, people often conclude somebody did something wrong. Or that everybody did everything right, but the original decision - the choice that led to the problem - was wrong. But these may be the wrong conclusions.
Patients and the healthcare team can do everything right, and things can still go wrong.
What should intelligent, well-motivated patients do when their physicians refuse to prescribe what these patients believe is the best treatment? When I hear patients complaining, I urge them to find out why.