Dialogue Volume 12 Issue 3 2016 - Page 33

practice partner The Ethics of Communications I s doctor-patient communications part of medical ethics? “Clearly, it goes beyond the science,” says Dr. Philip Hébert. “There are less quantifiable but equally important aspects of medicine. Can you be a good clinician and not communicate well? I don’t think so. You can be a technical whiz, you can be a doctor without those skills, but you can’t be an exceptional doctor.” For over 20 years, Dr. Hébert was a family physician at Sunnybrook Health Sciences Centre in Toronto, where he also chaired the Research Ethics Board (he’s now Vice-Chair). Retired from clinical practice, he’s a bioethics consultant and a Professor Emeritus in the University of Toronto’s Department of Family and Community Medicine. Dr. Hébert is the author of Doing Right: A Practical Guide to Ethics for Physicians and Medical Trainees. Earlier in 2016, Doubleday Canada published his latest work, Good Medicine: The Art of Ethical Care in Canada. On the very first page, he writes that “We arrive as foreigners in the country of illness. Its flora and fauna, its language and customs are distinctive. The best guides for what can be a difficult journey are knowledgeable and empathetic health-care professionals. All must actively listen to patients and their loved ones so they can provide the best possible care.” A few months after Good Medicine came out, Dr. Hébert talked to Dialogue about why communications gets at the heart of ethical care. DOC TALK By Stuart Foxman Understand the patient’s story One of his enduring lessons came in 1983, during a surgical rotation as a fourth-year medical student. A widower he calls Jerry was having trouble swallowing. In the hospital, Dr. Hébert chatted with him often. He learned about Jerry’s life, that he was a retired librarian and avid book collector. Dr. Hébert recalls being chastised by one clinician. “Are you interviewing the patient or having a conversation with him?” he asked. Jerry’s tests confirmed squamous carcinoma of the esophagus. The tumour was wrapping around major blood vessels and reaching to Jerry’s heart. A surgeon strongly suggested removing what he could. Dr. Hébert knew this surgeon would operate on almost anyone, and had many patients with serious postoperative complications. Later, Jerry couldn’t recall any detailed discussions of the risks or his prognosis. After ineffective surgery, Jerry developed multiple complications. He became septic, his kidneys began failing and he had a stroke. Jerry was in terrible pain and needed a feeding tube. He pulled it out, begging that it stay out. When Dr. Hébert raised Jerry’s objections, the senior resident called him “defeatist”. Two weeks later, feeding tube in place, Jerry died. “It bothers me to this day,” Dr. Hébert says. “I saw his suffer- Dr. Philip Hébert Issue 3, 2016 Dialogue 33