Talking to doctors about terminal illness

What doctors can tell you

Even though doctors are now getting more training in patient communication, they're sometimes the worse people to talk to about mortality. Often, they can be ill at ease with patients they can't cure, and find it difficult to break bad news. They feel as if they've failed them in some way and embarrassment or guilt makes them seem aloof or distant.

A doctor may give vague answers if you ask questions such as 'How long will I live?' He's not being obstructive; he's probably telling the truth. It can be difficult to predict exactly how much time you have left. Statistics can only give a broad idea. If, for instance, 70 per cent of those suffering your illness survive for five years, you've no way of knowing if you'll be one of those who live for that period or one of the 30 per cent with a shorter future.

Doctors should avoid exact numbers and instead use more general terms such as weeks, months or years. This should be helpful enough to allow families to plan for the future. When more exact predictions are given, patients can feel cheated if their time turns out to be shorter, and left 'in limbo' if they live beyond their 'due' date. It's best not to press your doctor for a precise figure.

How to help

You can help your GP and yourself in the following ways:

• Let your doctor know how much or little you want to know about your illness.
• Tell him when you've heard enough.
• Take a friend or relative with you to the clinic: it's a time of crisis and you may forget much of what's said to you if you're shocked by the news.
• If it helps, write things down or, with the doctor's consent, tape the discussion.
• Because doctors often forget that other professionals can help at this difficult time, ask what other local support is available, such as palliative care services.