27 Jun 2019

'Doctors can't escape vital conversations about end-of-life care'

From Nine To Noon, 10:05 am on 27 June 2019

Doctors have an important and unavoidable role to play in helping people reckon with mortality, says Melbourne oncologist and award-winning writer Ranjana Srivastava.

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Medical doctors are now very specialised and very good at focusing on the "minor minutiae" of treatments and interventions – even if they are futile, Dr Srivastava tells Kathryn Ryan.

Unfortunately, many are not so good at contemplating the whole of a patient's experience, she says, which leaves that person and their family feeling abandoned by the system and afraid.

'The truth' means different things to different people, Dr Srivastava says, and after more than 20 years as an oncologist, she's learned to ask each patient how much they want to know.

Doctors must respect what an individual is ready to hear – and tread a fine line between being realistic and not extinguishing hope, she says.

Some people immediately want their doctor to give them a clear-as-possible idea of life expectancy – others develop that desire later and some may never want to know.

Because doctors hold responsibility for keeping people well, they cannot escape being part of vital conversations about end-of-life care, Dr Srivastava says.

"We are charged with speaking to patients about whether treatment is working… these conversations often take place in the intensive care unit."

Bad news is difficult to deliver and difficult to hear but worse is someone going through difficult, complex, painful treatment with the mistaken belief that it will cure them, she says.

"When I see that, I feel very sad because I think somewhere we have let that patient and their family down."

Facing mortality brings out strong and sometimes conflicting emotions in patients and family members who commonly experience 'carer exhaustion', Dr Srivastava says.

She's noticed that the people who are better able to accept a terminal diagnosis are often those who consciously practise forgiveness and compassion throughout their lives.

"The people who tend to accept their mortality are people who are always asking themselves 'what matters? what is important?' and they don't leave these things for the last phase of life."

Dr Srivastava tries very hard not to judge what quality of life means to another person.

"[Making decisions about the end of your life] takes a great deal of courage, but beyond that, it takes self-awareness and a capacity to reflect on not what the world is doing but what is important to you."

Ranjana Srivastava is the author of A Better Death, Conversations about the art of living and dying well. Her previous books include  Tell Me The Truth: Conversations With My Patients About Life And Death and After Cancer: A Guide to Living Well