Preparing Ourselves, Our Trainees, and Our Patients: A
Commentary on Truthtelling
Timothy J. Moynihan and Lidia Schapira
In her article “Truthtelling,” it is abundantly
clear that Dr Lindsay E. Rockwell experienced a
on confronting the imminent death of her patient,
Jack, and the suffering of his loving father. She dis-
cusses the lack of communication with the patient
and his family and its significant impact on his care
near the end of life. Rockwell suggests the medical
There are many ways and opportunities for
communications to go astray, especially in such a
tragic case of a young man in the prime of life.
Oncologists spend many years mastering the many
nuances of chemotherapy and the management of
all associated toxicities, gaining confidence and
comfort dealing with treatment protocols and ad-
ficult concepts, such as risks and benefits of
treatment to patients, and how to frame these with
the appropriate use of statistics regarding response
iar, to describe the next regimen and its adverse
effects than to address the big picture and negotiate
goals of care. Discussing death and preferences for
end-of-life care should ideally flow from conver-
sations about life. Knowing what is important to
our patients, what they treasure and think is
worth fighting for, and how they wish to be re-
membered helps guide the dialogue when we run
out of treatment options.
need for open and honest communication about
prognosis and the consequences of not knowing.
Lack of training, a desire to avoid painful discus-
sions, an overly optimistic view of the effectiveness
of current therapies, collusion between physicians
physician’s silence. But communication is a two-
he simply could not bear to accept that modern
medicine and technology could not save his son.
truth. But was she present for all conversations?
current treatments and our collective failure to sal-
vage and rescue every patient from death is both
difficult and painful. It unleashes our own grief,
which is often repressed. Let’s face it: we work in a
culture that does not encourage the expression of
for our trainees.1Feelings of failure and sadness
complicate the oncologist’s response to a patient’s
sonable prolongation of futile therapies and the
This case illustrates the damage that can be
caused by avoiding frank discussions about death
with our patients and their families and not paying
enough attention to the well-being of our trainees.
We know that the time before death can be experi-
enced as a period of growth and transcendence.
able illness has an opportunity to avoid toxicities
acy of peace and love, and find solace in having
completed meaningful tasks. This is borne out in
practice and is the message repeated by those who
are dedicated to caring for dying patients. We need
founder of the modern hospice movement, who
taught that, given enough time and opportunity,
most patients find their own sources of strengths
physicians and on our more seasoned colleagues as
those mentoring junior colleagues in practice need
From the Mayo Clinic, Rochester, MN;
and Massachusetts General Hospital,
Submitted September 8, 2006; accepted
October 15, 2006.
Authors’ disclosures of potential con-
flicts of interest is found at the end of
Address reprint requests to Timothy J.
Moynihan, MD, Mayo Clinic, 200 First
St, Rochester, MN 55905; e-mail:
© 2007 by American Society of Clinical
JOURNAL OF CLINICAL ONCOLOGY
T H EA R T
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