Secondly, it is difficult to not feel some sense of failure with the death of any patient. Most of us are not good at discussing our failures. To discuss with a patient her anticipated death is to accept that we will be unsuccessful in our attempt to preserve life and to begin to plan for failure. Physicians typically avoid or curtail these conversations because they are awkward and painful. These conversations require skills that are not acquired in medical schools.
Medical school cultivate intelligent, active, innovative skills.
Patient listening and acceptance of the fact that there are not solutions or answers to every question are not cultivated attributes. Often, physicians fail to listen to patients' wishes about dying because it is painful to do so and no physician easily accepts helplessness. Alan B. Astrow, M.D. is Associate Chief of Hematology and Oncology at St. Vincents Hospital and Medical Center in New York City. He is also Assistant Professor of Clinical Medicine at New York Medical College. Dr. Fegan is president of the medical staff at Michael Reese Hospital in Chicago, where she is an attending physician in internal medicine.