Our role is to listen to our patients, guide them on their healthcare journey, and educate them on what they can do to help themselves. We can only do this when we are prepared ourselves. Just as we have developed our approaches for examining a patient, starting IVs, talking to families, documentation, and learning new skills, we must develop an approach to end of life conversations.

Of great concern to us, when we are face to face with a patient who has a life limiting diagnosis, is the impact of hope on our patients and their families. We do not want to be the person who takes their hope away, the one who causes them to give up their fight in case there is something we missed, or perhaps this is the patient who will beat the odds. We fear our words will set in motion a self-fulfilling prophecy for the end of a life. Our silence however, does even more damage.

“We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being.”
— Dr. Atul Gawande

We fail our patients when we let our fears get in our way. When we remain silent because we cannot give a predictable timeline for death, avoid a conversation that may include our patient’s religious or spiritual beliefs, or are uncomfortable with our own beliefs around end of life, we fail our patients. We do not give them the choice to make their decisions on what is important to them with limited time. We fail to let them live their life fully to their last moments.