Training physicians to care for the dying

The education of medical students and house staff regarding management of death and timely discussions of death with patients and families has been deficient, leaving physicians ill-equipped to provide appropriate care to dying patients.

We propose a five-pronged curriculum in terminal care to be ongoing from medical school through postgraduate training. This program includes: Clinical skills--including pain and symptom management, prognostication and care in various settings; Communication skills--including listening and how to discuss bad news with patient and family; Psychosocial issues; Administrative/management and team interaction, and Bioethical issues, including DNR and living wills.

It is hoped that such training will teach physicians to accept death as inevitable, to recognize and acknowledge the state of dying and, finally, to understand that appropriate care includes appropriate death, which is one arrived at with minimal suffering, with minimal social and emotional impoverishment, with preservation or restoration of important relationships and with resolution of residual conflicts.