What is your response to the question, "Is this terminal?"

Thanks for this question, it's really important.

This question comes up in two distinct scenarios: when a person is first diagnosed and when a person is nearing the end of her life.

Let's talk about them in sequence.

1). At diagnosis:

When a person is first diagnosed, this question is part of "getting their arms around" the disease. In that case, I believe I have to be both forthright and appropriately humble. Being forthright matters because if I shade the facts or avoid candor, I breach the pa...

First – thanks for bringing communication to the surface. A lot of people struggle with this question.

As VitalTalk volunteer faculty, I can offer the following evidence-based framework. (This reply is my own and not a statement from the VitalTalk non-profit organization).

When the patient asks, “Is this terminal?”

It’s not just a request for information, there's usually underlying fear. The brain can’t process facts and figures when the emotional center is in control, so don’t talk numbers yet.

S...

I would add one thing to the above discussion, which is to ask "why." Both these questions "is this terminal?" and similar prognostic question "how much time do I have?" require pause and contemplation on our part as well as the patients.

I ask myself, why is the question being asked? What would be done with that information?

So, I ask a clarifying question before answering, "what do you mean by that?" The responses I get are varied: sometimes they are worried about their symptoms, worried about...

I’m honest with them. I tell them that I’m sometimes wrong. I try to avoid telling them how much time they have with any precision because it’s hard to predict. I also discuss hospice. I tell them that I could be wrong. When asked, I give an estimate of lifespan. My patients have my cell phone number. I ask them to text and I will call.

My response to the specific question from a patient, "Is this terminal?" is "It's highly likely that this is the thing that's going to shorten your life." That a) honestly answers the question, and b) allows her or him to quickly move on to the subsequent questions that matter the most to their individual situation.

Wonderful responses. Like most, my approach has evolved over time with education, clinical experience, and exposure to the wisdom of respected clinicians.

I usually focus on prognosis delivery and assurance of continuity of care as two main themes.

Regarding prognosis delivery, I note that the physician is in a position of power and what I say carries both a conscious and an unconscious weight for the patient. I relate that I have seen cases of "medical hexing" in my career, where a well meaning...

I have learned a great deal from theMednet thread, and I thank everyone, and in particular, Dr. @Dr. First Last, for his wonderful response. Similar to others, my approach to these types of conversations has evolved as I have gained experience in practice. In fact, these conversations take practice, and I encourage everyone to utilize the Vital Talks material. I have few contributions to make to this conversation. I would emphasize the importance to make sure that this conversation takes place i...