The Consequence of Poor Communication
and Therapeutic Illusion
When communication is poor, patients and families can have a hard time understanding their options, asking the right questions, and making informed decisions. And it’s difficult for doctors to ascertain the patient’s preferences and wishes, especially if they avoid asking. Rather than focusing on bad news, doctors will instead offer more tests and treatments. “Within the medical community, it’s actually called ‘the therapeutic illusion.’—this concept that you can do something and it will make some kind of a difference,” said Dr. Jessica Nutik Zitter, “Doing something will give you some kind of control over the situation. And there’s no situation where people feel more out of control than when someone’s suffering or dying.”
UCLA professor in Public Health
Dr. Richard Jackson had his own personal encounters with therapeutic illusion and poor communication when his mother was dying of pneumonia in a New Jersey hospital. No one on the medical staff spoke with her family about end-of-life options or hospice. Instead, the doctors kept giving her tests and further treatments to keep her alive as long as possible, despite her expressed wishes to the contrary. “We had a parade of pulmonary doctors, heart doctors, ophthalmologists, blood docs, liver docs, you name it, one after another,” said Jackson, “And I kept saying, ‘Wait a minute. You’re doing all these tests and nothing’s happening.’ ”
Jackson’s mother had specified that she did not want to be resuscitated or intubated if she was nearing death, but her wishes were not included in her medical chart and her doctors refused to speak to him. “So I finally grabbed the head nurse and I walked her down the hall and I took her into my mother,” said Jackson, “And I said ‘Mom, do you want a code blue?’ ‘Absolutely not!’ ‘Do you want to be intubated?’ ‘Absolutely not!’ ”
The DNR and DNI preferences of Jackson’s mother were again recorded in her medical chart. Jackson said her stated wishes disappeared from her chart a third time when she was moved to a different room. “So in the last day or two, I came to her room and I saw two people on top of her,” said Jackson, “They couldn’t get blood out of her arms any longer. And they’re sticking catheters into her neck to get blood out of her. And ‘What’s going on?’ So I had to raise hell. I was seen as a trouble-maker. It was perfectly obvious to me this was the end of her life. It was perfectly obvious to her.”
The insertion of the catheter caused a huge hematoma that extended from her head to her chest. But thanks to Jackson’s intervention, his mother’s suffering finally came to an end, when she was transferred to a hospice. There, she was given warm, supportive care during her final hours.