"Breaking Bad News" is something every medical student has been taught lately. With sensitivity training, mindfulness, and scenario-acting classes - a plethora of med-ed literature exists on how to, why, and in which way one should perform the patient-doctor encounter. "SPIKES" is the go-to list on how to perform your way through the discomfort of it with giving bad news. Another acronym on a 'one-size fits all' response that lays the platform on learning the 'art' of it all later from that smooth consultant who, at one time in his or her career, fumbled his/her way through the list. But, that's always the issue with much of the OSCE-based training isn't it? For how good it can be, it is always a performance. A theatrical thespian model, which truth be told, most med-student populations are quite unaware of and you can probably put in any actor who would do a better job of it in any given moment. There are many articles written on the pros and cons of all of this, but here's a nice simple example. I take it from the play by Margaret Edson and subsequent movie "Wit" that drew accolades and stunned audiences. Besides the moving poetry of John Donne in the movie, Dr. Vivian Bearing (played by the superb Emma Thompson) mentions the almost 'cultural' norm of the hospital to ask, "how are you feeling?" while she's puking or hooked up through every orifice post-surgery. There's a wonderful irony here where the question itself is a performative near-professionalism that may often arrest your uncomfortable silence, but ignores every other aspect of the scene. The pre-dominance of performing the speech of "how are you?" neglects what the patient is going through and we're all back to square one on "showing" empathy and not really "being" it. Of course she's feeling like crap. She's puking. But why do medical professionals ask the question regardless? What we do know in this context is that the questioner is not truly listening and going through the performance, the distant motions of a norm. And with the background of the grand medical infrastructure, the often nebulous authority of medical professionals, and the all-permeating sickness - this can be a discombobulating and uncertain experience for whoever going through it. Perhaps - the only way to work through it would be with some... wit. Thus, subtlety. Language can be the world and also a reflection of the world. The baseline understanding of any encounter isn't one of equity - an idealistic point of view that is in it's core - comfortable. What is uncomfortable, inequitable, and unfair - is life comma death. A mere comma separates the two and it's better to be aware - in any encounter of death - not to see it as necessarily universally depressive and morose, but merely life and a comma. Or better yet, watch the movie "Wit" below. It's often used as mandatory teaching for nurses and health policy wonks in different universities, but be sure to bring some kleenex and some popcorn! Sang Ik is a 2nd year GEMs student.
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