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