Ethics Forum: Physicians Face Ethical Quandary Discussing Poor Prognosis with Patients

It should be noted that physicians may react to their own feelings about bad news. However, the priority of the clinician should be to understand the patient’s response to the news of the diagnosis. For both of these patients, the critical shared element is that the rheumatologist must listen and acknowledge the patient’s response and try to understand what meaning the patient attaches to the news. It is critical to listen with compassion and ask about sources of support.

How would you approach these cases?

When discussing a poor prognosis with your patients, what has worked well for you? And what has not?

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Rashmi Shah, MD, is a second-year rheumatology fellow at Oregon Health and Science University. She is also a board-certified geriatrician and was involved in providing complex care to community-dwelling frail older adults for four years prior to pursuing a fellowship in rheumatology.

Jennifer Barton, MD, is a staff rheumatologist at the VA Portland Health Care System and an assistant professor of Medicine at Oregon Health & Science University. She receives funding from NIH/NIAMS grant K23AR064372 and conducts research on patient–clinician communication in the rheumatic diseases.

Robert H. Shmerling, MD, is the clinical chief of rheumatology at Beth Israel Deaconess Medical Center in Boston and the chair of the ACR’s Committee on Ethics and Conflict of Interest.

References

1. Gillon R. Medical ethics: Four principles plus attention to scope. BMJ. 1994 Jul 16;309(6948):184–188.
2. Caplan L, Hoffecker L, Prochazka AV. Ethics in the rheumatology literature: A systematic review. Arthritis Rheum. 2008 Jun 15;59(6):816–821.
3. Beauchamp TL, Childress JF. Principles in Bioethics. New York: Oxford University Press, 1979:50.
4. Rabow MW, McPhee SJ. Beyond breaking bad news: How to help patients who suffer. West J Med. 1999 Oct;171(4):260–263.
5. Quill TE, Townsend P. Bad news: Delivery, dialogue, and dilemmas. Arch Intern Med. 1991 Mar;151(3):463-468.

Editor’s note: If you have comments or questions, or if you have a case that you’d like to see in Ethics Forum, e-mail us.