More on Caring Conversations…
Is your patient hoping for a miracle? If so, well done, doctor.
“Focus on a miracle”, is an expression of understanding that the likelihood of recovery is minuscule. If your patient or surrogate is hoping for a miracle, then you have been successful in communicating serious news.
Physicians are trained in a highly cognitive field. Patients’ belief in miracles can cause us to fear that the patient is “unrealistic” in their expectations of our ability to cure.
Our goal as “well-trained 21st Century physicians” is to guide our patients through disease treatment, which includes a recommendation for their plan of care. Our job is not to convince them out of the likelihood of a miracle, but to keep the conversation going.
Consider the following dialogue:
Provider: “I’m sorry to tell you the pancreatic cancer has spread to an area that makes surgery too dangerous.”
Patient: “Oh Lord! You can’t be telling me this. I am not dying. What about surgery?”
Provider: “I’m sorry, but surgery is not an option.”
Patient: “My church member survived this. I have people praying for me and we believe in miracles. Let’s do chemo.”
We often respond with more data (albumin, creatinine or functional status) and a wish that the patient would respond more cognitively. However, responding to an emotional reaction with medical information can derail the conversation.
Hope for a miracle need not be the end of a conversation; it can be the beginning of a new conversation.
Here are effective physician responses to the above patient comments:
A. “I’ll hope for a miracle, too.”
B. “It sounds like your faith is very important to you.”
C. “It sounds like you are hoping for a miracle. What else do you hope for?”
Try one of these replies the next time a patient expresses their hope for a miracle, and then pause to listen to his or her response.
For more reading on published evidence about responding to hopes for a miracle, see: Widera, Eric W.; Rosenfeld, Kenneth E.; Fromme Erik K.; Sulmasy Daniel P.; and Arnold Robert M, Approaching Patients and Family Members Who Hope for a Miracle; Journal of Pain and Symptom Management. July, 2011, volume 42 (1): 119-25.
This is one of many skills that can be practiced with the Caring Conversations Communication Program. Established by a group of Henry Ford physicians in 2012, the goal of the program is to improve conversations between providers and patients.
Caring Conversations has roots in the VitalTalk format and accordingly, utilizes highly skilled improvisational actors to create an ideal environment for experiential learning.
Henry Ford Health System Caring Conversations team members are: Rana Awdish, M.D.; Dana Buick, M.D.; Kristen Chasteen, M.D.; Michael Mendez, M.D.; Maria Kokas, Ph.D.; and Cari Williamson, BA.