Dying patients need a good relationship with their doctor

Editor—The common complaints of patients’ relatives about the undignified circumstances of death and lack of medical care of dying patients reveal an explosive situation and the need for doctor- patient partnership.¹ The development and specialisation of medical knowledge and the methods of diagnosis have lead to partial delegation of diagnosis and treatment to machines. This has resulted in an appalling loss of the human element in medicine and a consequent increase in the suffering of patients. The yearning of patients for treatment that considers the whole person is therefore justified from a human as well as a medical point of view. The more ill the patient the more horrifying the dilemma between the overpowering treatment and the psychological oppression. The certainty of death renders all technical data superfluous. Dying patients and their friends and relatives are confronted with simple needs that require fulfilment. However, when doctors cannot help their patients any longer they often withdraw treatment and seriously ill patients lose their attention.

A profound change of attitude is necessary in which psychological counselling is considered to be part of a doctor’s profession. Seriously ill patients and their doctors willingly or unwillingly have a close, unequal, and difficult relationship. Doctors have more power because they have knowledge, are healthier, and have the role of helper, and patients are dependent on them. Thus doctors are responsible for shaping the relationship with their patients. To shoulder this responsibility competently must be a goal of medical education.

Rightly, doctors are today accused of evading this responsibility. Though they treat the disease, they neglect the patient. Doctors can and do separate the mind from the body and treat them separately. Patients cannot do that. The total and effective treatment of patients with serious illness or who are dying demands competence in communication, an understanding by doctors of their own emotions and prejudices, and an ethical attitude. That means it demands a thorough training.

The knowledge required to treat a dying person competently is available but not within reach. No university in Germany has a chair of palliative medicine, and this subject is not included in the curriculum.

Individuality and cultural background affect the needs of patients. Doctors should learn to ask precise questions, listen accurately, and make plain that no subject is taboo. They should be ready to discuss any subject their patients are worrying about. Doctors should realise how they betray their patients psychologically by totally denying death and dying.