“There’s almost always, in every medical circumstance, one more thing we can try,” says Dr. Julie Bynum. But less often do we talk openly about whether it’s worth trying. Dr. Bynum is a gerontologist at Dartmouth’s Geisel School of Medicine and co-author of a study that found that while Medicare patients are increasingly choosing hospice or palliative care over heroic measures in their last days, many still go through futile hospitalizations and treatments first. Why is that? Dr. Bynum told the Los Angeles Times, “It’s hard for a doctor to say ‘I have one more thing I can do, but it’s not a good thing.’” She explained, “We’re pretty fearful of taking away hope.”
Reading this I found myself back in time—at one of our Monday morning staff meetings in the regional cancer center where I served as the staff medical humanist. Mondays at 8am, staff would review the upcoming week’s schedule: new patients, returning patients, patients whose prognoses were changing, for better and for worse. On that particular Monday one of our oncologists announced he had spent the weekend in search of “one more thing” to offer one of his patients. Studying the printout of the clinical trial in his hand he looked weary—frankly exhausted. I lay my hand on his. “Remember,” I said, “your oath was to do no harm… not to cure cancer.” He mumbled his thanks, quickly turning away as his eyes began to fill with tears.
It’s easy, sometimes, to forget that our doctors are human, too. They want to do the best they can for us. But in some cases, the “best” may be a candid conversation about what can be gained—if anything—from trying one more thing.
As a patient, you may have to give your doctor permission to tell you the hard truths. A doctor who is invited to be honest will be better prepared for these difficult conversations and to answer questions about prognosis itself, as well as the advantages and disadvantages of treatment. An understanding of all these factors is critical to helping patients choose the course of action that is right for them.