How do you tell someone something they don’t want to hear? Very carefully and with compassion in your words.

In thinking about the answer to the above question I have two different answers. Those answers depend on who is delivering the information.

Physicians: Nobody wants to hear they can’t be fixed, treatment is no longer working. BUT, it is your responsibility, as a physician, to tell a person whatever “bad” news you have determined. “I am having a difficult time fixing you. The medicines, the plan of treatment is not doing what we had hoped.”

A part of a physician’s responsibility is to tell the truth as they know it. That truth may not be what the patient and family want to hear BUT consider that knowledge a gift . It is giving the opportunity to address life issues, to do and say what needs to be done and said. That knowledge is a life opportunity, even though nobody wants to hear or acknowledge the message.

Tell that truth in a manner that the patient/family can understand. No medical words, look the person in the eye, sit rather than stand by the patient, speak slowly, gently, sincerely. It’s okay to say “I don’t know.” When addressing end of life issues do not put an exact number on a prognosis. Use months, but not “six“months. Dying is too personalized to be accurate with a number. 

Make recommendations for further care. That can be a referral to palliative care or hospice. Don’t just leave a person and family with no resources after you have told them they can’t be cured.

Palliative care and hospice nurses, social workers and end of life doulas: So often I’ve been told by families “Don’t tell mom the doctors can’t fix her. Don’t tell mom she is going to die sooner rather than later. Don’t tell her she is on hospice” 

It is our job, our responsibility as end of life workers to be honest with our patients. In a “don’t tell mom” situation I first assess where everyone is, who believes what. Then, I address the family’s concern. I tell them I don’t lie or play games, and let them know they can talk to me about anything. I am here to guide and support them and their family through this challenging experience. 

As part of my “don’t tell mom” support, if they would be more comfortable, I won’t address the subject of illness and decline directly. However, if asked, I will answer honestly in a supportive manner. I will be gentle, use my conversation and people skills. I will do my job of supporting a person where they are in this life altering situation.

As difficult as it is to tell someone “we can’t fix you”, to say those words nobody wants to hear, it is our job as health care workers to do so. A person has the right and physicians have the obligation, to tell a person ONCE that they can’t be fixed. What they do with that knowledge is for the person to decide.

They can take the opportunity to address life issues, put their affairs and relationships in order —- or not. BUT the physician has to tell them first. The physician has to have an honest, direct and gentle conversation. The physician has to give the gift before it can be officially acknowledged by the rest of us healthcare workers.

Something More about…  Telling Someone What They Don’t Want to Hear

I greatly encourage physicians to offer newly diagnosed palliative patients facing a life limiting illness  A Time to Live: Living With A Life Threatening Illness . This booklet addresses issues of comfort, nutrition, and sleep as they relate to the palliative care patient. It provides guidance to help them live the best life they can within the confines of their body and disease. 

When the patient begins hospice care the family will need education and support. Caring for the dying is different than caring for someone who will get better, but families don't know that. Most hospices offer my "little blue hospice book", Gone From My Sight: The Dying Experience. When the "labor" of dying begins The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death.