Dealing with Death & Dying in Medical Education and Practice
© 2001 Kirsti A. Dyer, MD, MS
AMSA Convention March 30, 2001
Strategies for Clinicians to Help Patients Who Suffer

1.  Finding Strength

  • Inquire about patient’s resources

  • "When bad things have happened to you before, how have you coped?"
    "What are your sources of strength?"
    "Who will you turn to for support?"
  • Prescribe resources available to the patient 
    • Regular follow-up 
    • Psychologist, social worker, home care referral
    • Chaplain or other clergy
    • Reading materials
    • Disease Specific Organizations
    • Internet news groups, bulletin boards, chat rooms
    • Support groups
2.  Enhancing Growth
  • Inquire about compensatory pleasures and skills

  • "Even though thre are some things you can no longer go, what activities can you still enjoy?"
    "Are there things about you this disease does not affect?"
    "Can you imagine getting better?"
  • Prescribe steps toward growth
    • Find times of growth in the past
    • Encourage volunteering
    • Challenge the patient's sense of limitation
3.  Embracing the moment
  • Inquire about current feelings and desires

  • "What do you feel like doing right now?"
    "Do you have any secret dreams or desires?"
    "Is there something you've always wished you could do? What is stopping you from doing it?"
    "How are you feeling today?"
  • Prescribe a redirections toward current reality
    • Help set priorities
    • Coordinate treatment with with personal goals
    • Meditation
4.  Searching for meaning in suffering
  • Inquire about the patient’s disease model & meaning of illness

  • "How are you doing withing yourself?"
    "What does this news mean to you?"
    "Does this news casre you in any way?"
    What do you think caused your illness?"
    "Where do you think your illness came from?"
    "Why did you come down with this now?"
  • Prescribe life examination exercises
    • Journaling writing, autobiography
    • Painting, deawing
    • Reminiscence
    • Life review
    • Revisit the past with photos, Visits to people, Travel
5. Seeking acceptance and reconciliation
  • Inquire about personal dissatisfaction

  • "What are you hardest on yourself about?"
    "What is the wrost thing you've ever done?"
    "Is there anything you've done in your life that you cannot forgive yourself for?"
  • Prescribe steps toward self-acceptance
    • Advanced care planning - make arrangements for when the patient is sicker or deceased
    • Discuss Durable Power of Attorney for Health Care
    • Distribute personal possessions
    • Goodbyes
  • Inquire about estranged relationships

  • "Is there anyone you really want to talk to before you die?"
    "Is there someone you've never been able to forgive?"
  • Prescribe reconciliation with significant others 
    • Communication by letter, visit, telephone, e-mail
    • Physician can offer to be present at diffiuclt meetings
6.  Achieving transformation - help to reach a state of grace, closure
  • Inquire about spiritual and religious beliefs

  • "Are you a spiritual or religious person?"
    "Do you ever pray or meditate?"
    "Has your life ever changed dramatically before?"
  • Prescribe movement toward transcendence
    • Spiritual mentor
    • Prayer
    • Letters to loved ones that an be opened after the patient's death

Rabow MW, McPhee SJ. Beyond breaking bad news: how to help patients who suffer. WJM 1999;171: 260-263. Available as PDF file at: 
Rabow, MW. Breaking Bad News: Managing the Aftermath. Presented at UCSF’s "End of Life Care for the Hospitalized Patient, October 2000.

Compilation of resources for this presentation and Website © 2001 Kirsti A. Dyer, MD, MS.
Journey of Hearts,