A Conversation We Can’t Afford to Get Wrong

As a physician who has spent over two decades in geriatrics, hospice, and palliative care, I’ve come to believe that the most important part of my job isn’t just writing prescriptions or managing symptoms — it’s having honest, compassionate conversations with patients and their families about what truly matters at the end of life.

These conversations are never easy. No one looks forward to talking about dying. But when we avoid the subject — when we rely on euphemisms, or wait until it’s too late — we rob our patients of the chance to make empowered, meaningful decisions.

It’s time we reimagine how we, as physicians, talk about end-of-life care. We need to approach these discussions with clarity, cultural sensitivity, and empathy — not fear.

The Truth About Hospice and Palliative Care

Too often, hospice is misunderstood as “giving up.” Palliative care is confused with end-of-life care only, rather than being recognized as a service that supports comfort, dignity, and quality of life — sometimes for months or even years.

I’ve seen families resist hospice until the final 48 hours of life, simply because no one explained what it really is. And I’ve seen the relief on their faces when they finally understand that hospice is not about doing less — it’s about doing what matters most.

That clarity begins with us — the medical team. Our words carry enormous weight, and how we deliver the message makes all the difference.

Start With Listening, Not Talking

One of the most powerful tools a physician has is silence. I’ve learned that before you explain anything about prognosis or care options, you need to first understand where your patient and their family are emotionally and culturally.

Ask open-ended questions like:

• “What do you understand about what’s happening right now?”
  
• “What fears do you have about what’s ahead?”
  
• “What matters most to you if time is limited?”
  

Let them speak. Let them cry if they need to. And don’t rush to fill every pause. These moments of stillness are where trust is built.

Be Clear, But Be Kind

There is a way to tell the truth without destroying hope. Patients deserve to hear the truth — but they deserve to hear it gently.

Instead of medical jargon, use language that is both honest and human:

• “I wish I had better news.”
  
• “This is a time when comfort may be more important than cure.”
  
• “We’re not giving up — we’re shifting the focus to what brings you peace.”
  

I’ve had patients thank me after difficult conversations. Not because they liked what I had to say, but because they finally understood. They felt included in the plan. That understanding is empowering.

Respecting Culture and Faith

One of the most complex parts of end-of-life care is navigating cultural and religious beliefs. In some cultures, families prefer not to tell the patient the full truth. Others want the physician to speak only to the eldest son. Some believe suffering is redemptive; others prioritize maximum comfort.

Rather than assuming, ask respectfully:

• “Are there any traditions or beliefs that should guide how we approach this?”
  
• “Who would you like to be involved in making decisions?”
  
• “Is there a spiritual advisor you’d like us to include?”
  

By showing respect for a patient’s values — even when they differ from our own — we show respect for their humanity.

The Ethical Balance: Hope vs. Honesty

Physicians often struggle with balancing hope and honesty. We don’t want to take away a patient’s sense of possibility. But avoiding the truth can lead to unnecessary suffering — painful treatments, frequent hospitalizations, or missed chances for closure.

I always ask myself: Is this treatment adding meaningful time or just prolonging dying? Is the patient aware of what they’re choosing? Have I painted a full picture?

Being ethical doesn’t mean being cold. It means offering all options, including comfort care, and making sure those options are understood.

Training the Next Generation

As an Assistant Professor at UT Memphis, I teach medical students and residents not just how to diagnose and treat, but how to talk. We role-play tough conversations. We discuss real-life cases. Because no matter how skilled you are with a stethoscope, if you can’t sit with a grieving family and speak from the heart, you’re missing the most vital part of this work.

My goal is to prepare them for those moments when a patient asks, “Doctor, how much time do I have?” or when a son looks to them for guidance after his mother’s third hospitalization in a month.

These are defining moments — for the patient, and for the physician.

It’s About Dignity

At the end of life, what most people want is not a miracle. It’s dignity. They want to be comfortable. They want to be with family. They want to be seen.

Our role as physicians is not to fix everything — it’s to stand with our patients, to guide them with honesty and kindness, and to ensure that no one walks the final chapter alone.

Let’s have these conversations earlier, more often, and with greater courage. Let’s lead with empathy, not fear.

Because when done right, these conversations don’t just mark the end — they create moments of peace, clarity, and even healing.