Talking to Patients: A Lecture Series in Moldova

Paul L. Hart, MD

Jewish Healthcare International (JHI) was an outstanding Non-Governmental Organization (NGO) that would contact small medical communities and ask if they needed assistance with medical education. Then the JHI would send volunteers to present talks on the topics requested and clinics held with the local providers. Many of the missions were to countries in the former Soviet Union. A group of 30 physicians, nurses, and healthcare aides, working with JHI would present the lectures. The same lectures. would then be repeated, usually five to six times to different groups.

Moldova was perhaps the poorest of the countries in the former Soviet Union, and the coordinator there had requested a lecture on patient communication. I was to be the presenter.

My topic: “Talking to your patient.” The first time I gave this talk, I began by asking the question, “If a patient you knew had advanced cancer (and whose death was quite plausible) asked you, ‘doctor, do I have cancer, and will I die from it?’ how would you reply?”

In the past, if I had asked the participants a simpler question such as, “What medication do you usually use first for hypertension?” I would get a few hands with a quiet room. But not this time.

Once I posed the question and waited for replies, I noticed a change in the room. The participants were suddenly more alert, some seemed anxious, and others talked to their neighbors.

The first response from the audience was, “No, I would tell them that they were going to be alright.”

“If we revealed their chances, they would become more distressed and die sooner,” another observer replied.

“Why should I make them feel uncomfortable?” someone else shouted out. The room was palpably energized. Not one of the participants wanted to let their patients know the actual status of their health. Some of the participants actually seemed angered by my question.

I then asked another question: “If this was you, would you want to know?”

“Yes” was a nearly universal answer.

Talking to Patients Continued

As I probed a bit more, none of the providers were aware of Kubler Ross and her work on stages of dying in terminally ill patients. It turned out to be common practice among these providers not to present the patient with the facts about their situation.

I suggested that they may want to consider a change in their approach and gave some information about how this situation was approached in the U.S.

I repeated this lecture a number of times. The next time I began by saying that what I was going to discuss was a little different from how medicine was practiced in their community. This did not work; I encountered the same reply and level of anxiety in the room. I went as far as to say my talk may be controversial, but please look at these ideas as just ideas and not a recommendation to change your practice pattern. Still, the response remained the same.

I had always considered these replies wrong and not in the best interest of the patient, until I began writing this article. The rather uniform responses from our overseas colleagues demonstrated that not all doctors are following what is standard practice in the United States. Without categorizing different approaches as right or wrong, the differences do underline what our duty is to our patients facing the end of life, and why we would consider approaching our patients in a manner different from that we ourselves would prefer.

Paul L. Hart, MD, Retired Family Physician, Sterling, MA Email: paulhart46@yahoo.com