Becker's Clinical Quality & Infection Control

31 PATIENT & CAREGIVER EXPERIENCE Viewpoint: When telling the truth harms patients By Erica Carbajal B eing truthful with patients about their prognoses is one of a physi- cian's most difficult responsibilities. But when critically ill patients are in denial during their last hours, it only adds more pain, a pulmonary and critical care physi- cian wrote Oct. 6 in an opinion piece for The New York Times. Daniela Lamas, MD, a physician at Boston-based Brigham and Women's Hospital, wrote about her experience with a colon cancer patient whose disease was beyond treatment. After his colon cancer diagnosis, the pa- tient "disappeared from medical care" and didn't respond to follow-ups to schedule appointments and start chemotherapy. When he arrived in Dr. Lamas' intensive care unit nearly a year later, his disease was beyond treatment and there was nothing more the team could do apart from provid- ing comfort during his final hours. e patient displayed "impenetrable denial," insisting nothing was wrong with him and that he wanted to go home, Dr. Lamas wrote. She recalled her response to the patient: "I wish there were something we could do, but the cancer is too advanced. You're dying. It could be hours now. I don't think you will make it through the night." Part of this response was an attempt to cut through the patient's denial, and part of it was her own frustration "at the avoidable na- ture of this tragedy, at how denial had turned deadly," Dr. Lamas wrote. "is man was scared and he was going to die of a disease that might have been cured. And I could do nothing about it. When I told him that he had only a few hours to live, I allowed my frustration to obscure the reality of his suffering." e patient died later that night, and over the next few days, Dr. Lamas couldn't shake that moment at the patient's bedside from her memory. "What had I hoped to accomplish? As a doctor and purveyor of science, it can be difficult to accept that sometimes the 'truth' is not what a patient needs. Denial was my patient's only defense mechanism. And as soon as the words le my mouth, I realized how cruel it was to try to take this defense from him in the final hours of his life," the physician wrote. In most situations, it is in fact a physician's duty to tell patients the truth, but in this case it only added to a patient's pain in his final hours, Dr. Lamas wrote. "I wish that I had done it differently. I could have paused and told him that yes, he was going to go home. I could have simply been there with him and said nothing at all. at small kindness might have done more for him than the truth." n Sexual identity may affect career trajectory among med students, study finds By Cailey Gleeson M edical students identifying as sexual minorities are underrepresented in undergraduate medical training and among certain specialties after graduation, ac- cording to a study published Sept. 30 in JAMA Network Open. Using anonymized, self-reported data from Association of American Medical Colleges between 2016 and 2019, researchers conducted a survey of 58,572 students aiming to identify the distribution of sexual minority students in intended specialties. Three takeaways: 1. Sexual minority female medical students were more likely to intend to practice in surgical specialties and less likely to intend to practice in primary care specialties compared to their heterosexual female peers. 2. Sexual minority male medical students were more likely to intend to practice in primary care specialties and less likely in surgical care specialties compared to their heterosexual male peers. 3. Sexual minority female medical students may be under- represented in undergraduate medical training, as only 5.7 percent identified as sexual minorities compared to the estimated 9.4 percent of women who identify as sexual minorities in the general population. Researchers said limitations to the study included a lack of gender identity data, delineation of gender from sex assigned at birth and intersectionalities between multiple minority identities. n "I could have simply been there with him and said nothing at all. That small kindness might have done more for him than the truth." -Daniela Lamas, MD, Brigham and Women's Hospital

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