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Why so many doctors will not break bad news



After nearly 40 years as an internist, Dr. Ron Naito knew what the sky-high results of his blood test meant. And it was not good

But when he turned to his doctors last summer to confirm the dire diagnosis – stage 4 pancreatic cancer – he learned the news in a way no patient would. Naito had known for 10 years, refused to acknowledge the results of the "off-the-scale" blood test that showed unmistakable signs of advanced cancer. "

A second specialist performed a tumor biopsy, and then discussed the results with a medical student outside the open door of the exam room where Naito waited

"They walk by one time and I can hear [the doctor] say '5 centimeters,'" said Naito. "I knew what it was," Naito said last month, his voice thick

with emotion. "Once [tumors grow] beyond 3 centimeters, they're big. It's a negative sign. "

The mischievous delivery of his grim diagnosis left Naito determined to share one final lesson with future physicians: Be careful when you tell the patients they are dying. six months to live, Naito has mentored medical students at Oregon Health & Science University and was publicly speaking on the need for doctors to improve the way they break bad news

"Historically, it's something we have never been taught," said Naito, thin and bald from the effects of repeated rounds of chemotherapy. "Everyone feels uncomfortable doing it. It's a very difficult thing. "

Robust research shows that doctors are notoriously bad at delivering life-altering news, said Dr. Anthony Back, an oncologist and palliative expert at the University of Washington in Seattle, who was not surprised that Naito's diagnosis was poorly handled

"Dr. Naito was given the news in the way that many people receive it, "said Back, who is co-founder of VitalTalk, one of several organizations that teach doctors to improve their communication skills. "If the system does not work for him, who is going to work for?"

Up to three-quarters of all patients with serious illness receive news in what researchers call a "suboptimal way," Back estimated. ] "Suboptimal" is the term that is less offensive to practicing doctors, "he added.

The poor delivery of Naito's diagnosis reflects common practice in a country where Back estimates that more than 200,000 doctors and other providers could benefit from communication


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