“I Wish Things Were Different”: Expressing Wishes in Response to Loss, Futility, and Unrealistic Hopes
Authors: Timothy E. Quill, Robert M. Arnold, Frederic Platt
Journal: Annals of Internal Medicine (2001)

Medical Writings2 October 2001"I Wish Things Were Different": Expressing Wishes in Response to Loss, Futility, and Unrealistic HopesTimothy E. Quill, MD, Robert M. Arnold, MD, and Frederic Platt, MDTimothy E. Quill, MDDr. Quill: University of Rochester School of Medicine and Dentistry; Rochester, NY 14642Dr. Arnold: University of Pittsburgh School of Medicine; Pittsburgh, PA 15213-2582Dr. Platt: University of Colorado School of Medicine; Denver, CO 80205, Robert M. Arnold, MDDr. Quill: University of Rochester School of Medicine and Dentistry; Rochester, NY 14642Dr. Arnold: University of Pittsburgh School of Medicine; Pittsburgh, PA 15213-2582Dr. Platt: University of Colorado School of Medicine; Denver, CO 80205, and Frederic Platt, MDDr. Quill: University of Rochester School of Medicine and Dentistry; Rochester, NY 14642Dr. Arnold: University of Pittsburgh School of Medicine; Pittsburgh, PA 15213-2582Dr. Platt: University of Colorado School of Medicine; Denver, CO 80205Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-7-200110020-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Physicians who care for patients encounter many powerful and painful emotions, including anger, sadness, fear, grief, loss, hopelessness, and blame. Many studies suggest that physicians should express empathy in response to emotion-laden patient statements to ensure that patients feel listened to and understood. These physician responses usually consist of efforts to comprehend how things feel to the patient and to express that understanding back to the patient (1–8).Situations that evoke loss, guilt, or hopelessness are particularly hard for physicians to respond to empathically. Physicians who think that they have failed a dying patient and who fear depriving the patient ...References1. Branch WT, Malik TK. Using 'windows of opportunities' in brief interviews to understand patients' concerns. JAMA. 1993;269:1667-8. [PMID: 8455300] CrossrefMedlineGoogle Scholar2. Roter DL, Hall JA, Kern DE, Barker LR, Cole KA, Roca RP. Improving physicians' interviewing skills and reducing patients' emotional distress. A randomized clinical trial. Arch Intern Med. 1995;155:1877-84. [PMID: 7677554] CrossrefMedlineGoogle Scholar3. 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Matthews DA, Suchman AL, Branch WT. Making "connexions": enhancing the therapeutic potential of patient-clinician relationships. Ann Intern Med. 1993;118:973-7. [PMID: 8489112] LinkGoogle Scholar10. Nightingale SD, Yarnold PR, Greenberg MS. Sympathy, empathy, and physician resource utilization. J Gen Intern Med. 1991;6:420-3. [PMID: 1744756] CrossrefMedlineGoogle Scholar11. . Concise Oxford English Dictionary. 7th ed. Oxford: Oxford Univ Pr; 1993. Google Scholar12. Rie MA. The limits of a wish. Hastings Cent Rep. 1991;21:24-7. [PMID: 1938347] CrossrefMedlineGoogle Scholar13. Ackerman F. The significance of a wish. Hastings Cent Rep. 1991;21:27-9. [PMID: 1938348] CrossrefMedlineGoogle Scholar14. Delvecchio Good MJ, Good BJ, Schaffer C, Lind SE. American oncology and the discourse on hope. Cult Med Psychiatry. 1990;14:59-79. [PMID: 2340733] CrossrefMedlineGoogle Scholar15. Quill TE, Cassel CK. Nonabandonment: a central obligation for physicians. Ann Intern Med. 1995;122:368-74. [PMID: 7847649] LinkGoogle Scholar16. Lo B, Quill T, Tulsky J. Discussing palliative care with patients. ACP–ASIM End-of-Life Care Consensus Panel. American College of Physicians–American Society of Internal Medicine. Ann Intern Med. 1999;130:744-9. [PMID: 10357694] LinkGoogle Scholar17. Quill TE. Perspectives on care at the close of life. Initiating end-of-life discussions with seriously ill patients: addressing the "elephant in the room.". JAMA. 2000;284:2502-7. [PMID: 11074781] CrossrefMedlineGoogle Scholar18. Byock I. Dying Well: The Prospect for Growth at the End of Life. New York: Riverhead Books; 1997. Google Scholar19. Quill , Timothy E. A Midwife through the Dying Process: Stories of Healing and Hard Choices at the End of Life. Baltimore: Johns Hopkins Univ Pr; 1996. Google Scholar20. Fox RC. Experiment Perilous. Physicians and Patients Facing the Unknown. Glencoe, IL: Free Pr; 1959. Google Scholar21. Lazare A, Eisenthal S, Frank A. Clinician/Patient Relations II: Conflict and Negotiation.. In: Lazare A, eds. Outpatient Psychiatry: Diagnosis and Treatment. 2nd ed. Baltimore: Williams & Wilkins; 1989:157-71. Google Scholar22. . Kohn LT, Corrigan J, Donaldson MS, eds. To Err Is Human: Building a Safer Health System.. In: Kohn LT, Corrigan J, Donaldson MS, eds. Committee on Quality Health Care in America, Institute of Medicine. Washington, DC: National Academy Pr; 2000. Google Scholar Author, Article, and Disclosure InformationAuthors: Timothy E. Quill, MD; Robert M. Arnold, MD; Frederic Platt, MDAffiliations: Dr. Quill: University of Rochester School of Medicine and Dentistry; Rochester, NY 14642Dr. Arnold: University of Pittsburgh School of Medicine; Pittsburgh, PA 15213-2582Dr. Platt: University of Colorado School of Medicine; Denver, CO 80205Acknowledgments: The authors thank the American Academy on Physician and Patient and the Bayer Institute for Health Care Communication. Both organizations have helped the authors to develop their skills in counseling patients and in teaching the physicians these skills.Corresponding Author: Timothy E. Quill, MD, University of Rochester Medical Center, 601 Elmwood Avenue, Box 601, Rochester, NY 14642.Current Author Addresses: Dr. Quill: University of Rochester Medical Center, 601 Elmwood Avenue, Box 601 Rochester, NY 14642Dr. Arnold: Montefiore University Hospital, 200 Lothrop Street, Suite W932, Pittsburgh, PA 15213-2582.Dr. Platt: 1901 East 20th Avenue, Denver, CO 80205. 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