One of our goals for improving this system must be to create professionals trained in palliative care who can pass on their knowledge to students and other clinicians. We surveyed young physicians at a major academic medical center and learned that although they have conversations with dying patients on a weekly or even daily basis, they have infrequently had the opportunity to observe more skilled physicians talk with their patients. In truth, one needs to see and do many more prior to being well trained, however, the general model is successful and has led to highly skilled clinicians. Unfortunately, communication skills are not regarded with the same scrutiny that we use for other procedural skills and oversight is insufficient. We must recognize that one can hurt a patient with misplaced words just as severely as one can hurt a patient with a misplaced scalpel.
Research shows that poor communication leads to worse patient outcomes.
Clearly, we have a problem in medical education. But even the experienced clinician who turns to a typical medical or nursing text is unlikely to find much help in caring for a dying patient. Last year, a study of the major medical textbooks revealed that information on end of life care was sorely lacking. Even oncology textbooks were missing this information. Although nursing has frequently been ahead of medicine in this regard and, as a profession, has spearheaded the development of hospice care, nursing textbooks don't fair much better.