Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Coming Back Later


I learned from my patient with terminal lung cancer that it’s often helpful to give time to process bad news before making a medical plan together.  

When I met Mr. R, he had long-standing lung cancer that had been in remission for many years, but he started to have difficulty walking and was admitted back to the hospital. Tests revealed metastases to the brain and liver, and his disease was declared incurable. It was, obviously, horrible news.  


As we discussed hospice, I could see the pain and anguish in his eyes, as well as the tears he was holding back. His nonverbal reactions to the news told me that this was moving too fast. He wasn’t in a place to make any decisions.  


As a medical student, I may not be the one determining the final medical plan, but I can be the one to follow up when someone has had a hard day or when I get the feeling that they have more to say. 


Later, I returned to his room and said, “I know this is hard. We’re here for you and whatever decision you make. What’s most important to you right now?” 


He opened up. We talked about his family support and what keeps him going. How he just wants to be at home with his dogs and to travel again.  


I learned from Mr. R that acknowledging how hard someone has fought and is still fighting can be a powerful way to connect with patients. It can also be helpful to revisit a patient at a later time, when they’ve had time to process disappointing news. 


I hope I can continue to lean into those human moments, even when I am more pressed for time as a resident and practicing physician. 












This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.