What Doctors Know About How Bad It Is, and Won’t Say

  • 2016-07-06
  • The New York Times

Until a severe stroke sent him to a neurological intensive care unit in December 2014, Ernest Kohn was a particularly vibrant 90-year-old, still teaching a graduate economics class at Queens College.

So his family thought he might rebound. But when his son, Jerry, asked the rotating flotilla of neurologists what was likely to happen — would his father survive? go home? — no one really wanted to address his questions. “When you pushed them, they said, ‘We can’t say anything with surety,’” Mr. Kohn said.

“I kept saying, ‘I’m only asking for your opinion, not a guarantee. I’d really like to know what your 30 years of medical knowledge and experience tell you.’ Most of them would just clam up.”

We’ve known for years that doctors hesitate or even decline to discuss a poor prognosis with patients and their families. They fear that bad news will dash hopes; they don’t want to appear to be giving up. Often, their training hasn’t prepared them for sensitive conversations.

One researcher told me that oncologists believe that if they fail to offer yet more chemotherapy, even when that’s futile, patients will leave, seeking another doctor who will.