The difficult conversations that doctors have with patients

This week on the Friday Roundtable we had three doctors in to discuss what they wished they had understood about medicine when they started their careers. After the taping ended, I asked, "What was the first hard conversation you had to have with a patient or their family?"

Craig Bowron is a hospitalist at Abbott Northwestern Hospital:

It was an old alcoholic guy who was dying. And we were talking to the two daughters about what was going on, and it became clear through a series of conversations that he had abused his daughters both physically and sexually. And it became clear that the one daughter thought he couldn't go to hell fast enough and burn fast enough. And the other one wanted him to live so that he would say "I’m sorry."

And you know, you’re just fresh out of med school and you’re like, “This is quite a place to be in. Didn’t learn that in med school.”

Jim Pacala is associate head of the University of Minnesota's Department of Family Medicine and Community Health. He currently serves as president of the American Geriatrics Society.

I was doing pediatrics the first month of my residency and a kid came in who was about 2-and-a-half who had developed a condition called ITP, where your platelets--your clotting cells--your body doesn’t produce them. And so you start to bleed. And you're bleeding from everywhere. And he had a big bleed in his brain.

And this was a kid who was born completely normal, completely normal childhood. The couple had married late and this was their only shot at having kids. And it came to the point where my job was to keep that kid's organs perfused so they can harvest the organs for the transplants. He was brain-dead.

This had all happened in the span of a very few days, and so you can imagine the shock. These people were so nice. It’s still hard for me to talk about. That was tough. Really tough.

Meghan Walsh is chief medical education officer at Hennepin County Medical Center.

I remember as an intern having a young, alcoholic patient who came in with end-stage liver disease in the ICU, and who basically was not going to survive the ICU stay and didn't want any more care.

The conflict wasn't caring for him, because he just said, “Stop everything.” It was your boss. Your attending. Doctors want to do things. They want to fix things. They keep saying, "Do more, do more, do more." And the patient said, "No."

That was also another era. I think we do it better. Allowing patients to die; some physicians have a really hard time with that.

It’s easier to live than die in America. In a hospital.

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