Regarding your recent editorial ("Health systems must grapple with end-of-life issues," June 15, p. 54), I wrote a similar article in 1979, which was published in Hospital Physician. In it I described a small study I conducted among hospital-based interns and resident physicians.
The fact that these physicians treated their terminally ill patients differently than they would want themselves or their loved ones treated supports what I, a registered nurse, had observed. Silence, stonewalling and avoidance were the communication techniques of choice. Pain control and other quality-of-life issues were given short shrift.
Many of my RN colleagues and I often had to resolve the ethical dilemma posed by patients who clearly wanted to talk about their condition truthfully and directly and physicians who indicated in the patient's record that the patient was not aware of the prognosis. This was complicated by caring for patients whose pain and anxiety were undertreated, therefore hindering any possible quality time left for these people. We also had to contend with well-meaning family members who, in their effort to "protect" their loved ones, unwittingly caused more harm by enforcing silence or diversion.
As a patient advocate and professional healthcare provider, my path was clear-my patients came first. The physician's focus on cure often directly opposes the reality that no one gets out of this life alive. Death is the antithesis of cure.
The issues I described in my article almost 20 years ago seem to persist today. Quality of life should be the focus.
Fort Lauderdale, Fla.