Dr. Cicely Saunders, in a paper entitled "Uncertainly and Fear," quotes herself as asking a patient who knew he was dying what he looked for above all in the people who were caring for him. The reply was, "For someone to look as if he is trying to understand me." In this paper on the problem of establishing communication with the seriously ill patient, we are striving toward the practical and difficult goal of making it easier for all involved in the care of the seriously ill patient to look, talk and act more as if they understood what was going on.One of the more formidable obstacles that confronts and tends to inhibit anyone who assumes the responsibility of coping with serious illness-who attempts to study and conceptualize the problems which arise in dealing and communicating with people facing death-is the risk of being overwhelmed by the enormity of the issues involved. Fundamental human biological questions of life and death, health and disease, how they are related to each other and how we deal with them, immediately come to the fore. The responsibility of the medical profession, how better to share this responsibility with other members of the health and helping professions involved and what we really mean by patient care, are problems not easily avoided. The organization and quality of our hospitals, the attitudes and definition of the rapidly changing roles of the people who staff them, as well as a host of other educational, sociocultural, economic, psychological, communication, as well as philosophical and religious considerations are challenges confronting the serious student Turning directly to the problem of establishing communication with the seriously ill patient, the goals of such communication are the fundamental ones of seeing: 1) that the patient maintains the maximal vocational, sociocultural, and familial functioning of which he is capable; 2) that he cooperates fully with measures directed toward his welfare and survival. Denial on the patient's part may or may not be adaptive. The question to ask about denial of illness is-does the denial interfere with his well-being or acceptance of necessary care? 3) that the patient does not give up his usual sources of pleasure; 4) that the patient does not cause himself more pain and distress than is already inherent in his condition and situation. This last goal, although negatively stated, is of considerable positive importance. How to keep out of trouble or not cause more for the patient are frequent questions from family, professional staff, and especially students.Our main concern is with the hospital situation and the interaction there between the patient and the people responsible for his care. The hospital setting is a most difficult one; one of my colleagues maintains that hospitals are no place for sick people. The number of people involved in the treatment of the patient is constantly increasing. There is frequently little continuity and coordination of care, especially in our teaching hospitals, and methods of communication often leave...
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