‘Doctors want to cure’ patients, not tell them they’re dying

Amy Berman was diagnosed with terminal breast cancer when she was 51. In an essay for Health Affairs and The Washington Post, the former nurse reflects on her decision to pursue palliative care, after doctors initially steered her towards more aggressive treatment:

I realize that doctors want to cure, to save lives, to instill hope. Perhaps that also makes it difficult for them to tell patients they’re dying. Maybe, hoping that each terminally ill patient will be that one-in-a-million miracle outlier who lives, doctors temper their words. “Terminal” becomes “advanced illness.” The words “we’re going to treat this aggressively” are uttered even though treatment isn’t cure. Patients like the sound of “treat aggressively.”

It seems as if doctors are fighting for us, but few truly understand what the phrase means. Because of my nursing background, I know all too well. Is there a downside to aggressive treatment? You bet. In the case of incurable cancer, it can mean rounds of radiation or chemotherapy, or both, with side effects of crushing fatigue, overwhelming nausea, burned and peeling skin, permanent pain or numbness of fingers and toes, and the cognitive impairment known commonly as “chemobrain.” The “treat aggressively” approach can leave patients bruised and battered, wishing they were dead.

Yes, perhaps, a few months of added life come with it—but at what cost? Furthermore, recent evidence suggests that people with certain cancers might actually live longer—and better—using a palliative approach, such as the one I’m taking

Read the full essay here.