Life Matters Media
Quality of life at the end of life

Be Honest, Doc, Start Using The ‘D’ Word

BY DANIEL GAITAN | daniel@lifemattersmedia.org

Enough is enough. It’s time that doctors tell their dying patients that they are dying.

That’s the message that oncologist Dr. Aroop Mangalik hopes to hammer home with his first book to be published later this winter, Dealing with Doctors, Denial, and Death: A Guide to Living Well with Serious Illness. 

For far too long, Mangalik writes, physicians have unintentionally harmed terminally ill patients and their families by giving them false hope in modern medicine and scientific “breakthroughs.”

Sometimes disease cannot be cured, and that’s perfectly okay, Mangalik writes. Death is a part of life.

“Giving bad news is difficult for everybody, but you would think and hope that doctors would be trained to do that, but they’re not,” Mangalik told Life Matters Media.

“Only in the last five or six years has there been a movement in medical schools to improve doctors’ skills and make them confident that giving bad news is not creating bad news.”

Although death cannot be avoided, it may be prolonged. That time-stretch is often to blame for unnecessary pain and suffering at the end of life and for driving health care costs skyward.

“If (doctors) say anything positive – ‘we can have this treatment’ or ‘things are not looking very good’ or ‘who knows what will happen’ – the patient is going to hang on to that,” Mangalik said. “That doesn’t help the patient. You have to be very clear.”

Mangalik served as an oncologist at the University of New Mexico Health Sciences Center for more than 30 years, until his retirement in 2013. He is now an associate professor at the school’s Institute for Ethics, where he explores issues regarding equality and health care costs.

… giving bad news is not creating bad news

“Working as an oncologist, I saw a lot of patients who were suffering because they were being treated in situations when there was no chance of anything benefitting them,” Mangalik said.

Because doctors are trained to be hardworking and “not to fail,” Mangalik  said it is high time to change their perceptions about end of life care.

“If you view the death of your patient as a failure, then all you are going to do is hurt the patient,” Mangalik said.

Blame The Media, Too

Dr. Aroop Mangalik

Mangalik believes that doctors feel pressured to keep pumping patients with pills and poisons, partly because they don’t know how to say “ no” when patients demand them.

“There’s always some new treatment reported in the newspapers and on TV, that puts pressure on the patients,” he said. “There’s always a ‘breakthrough.’ It’s a vicious cycle. One feeds into the other. With all these ‘breakthroughs,’ you would think people would live forever.”

Research shows that end-stage patients experience a more peaceful death and better quality of life if enrolled in a palliative care or hospice program. The goal of such care is comfort, not cure.

An extensive study led by Dr. Ziad Obermeyer, an emergency medicine physician at Brigham & Women’s Hospital, found that critically ill patients enrolled in hospice are far less likely to opt for costly, unnecessary invasive procedures and die in hospitals.

Dealing with Doctors, Denial, and Death: A Guide to Living Well with Serious Illness will be released on January 16th by Rowman & Littlefield Publishers.

– Image courtesy Death to Stock Photos