Here’s Why A Doctor Looks At His Dead Patients’ Facebook Before Breaking The News To Their Parents

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It’s undoubtedly one of the toughest parts of a doctor’s job. Yes, that moment when they have to inform a family that a loved one has passed away never gets easy. But one professional goes above and beyond when planning to deliver such sad news; he checks the deceased’s social media.

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The man in question is Louis M. Profeta, who’s worked at St. Vincent’s Hospital in Indianapolis since 1993. During his lengthy stint there, the medical professional has served as the head of mass casualty preparedness, a clinical instructor of emergency medicine and an emergency physician. He’s also a gifted writer, having penned a book about spirituality and his profession titled The Patient in Room Nine Says He’s God.

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And in 2018 Profeta went viral with a post that he shared on LinkedIn about a particularly heartbreaking issue. In a piece named “I’ll Look at Your Facebook Profile Before I Tell Your Mother You’re Dead,” the physician discussed how and why he uses social media during the toughest aspect of his job. So here’s a look at his touching story and how the medical profession deals with giving bad news.

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In 2017 health services researcher Vincent Mor wrote a piece for the Health Affairs Blog, and there he claimed that almost 50 percent of physicians have no idea how to deliver bad news effectively. As a result, Medical News Today questioned various palliative care practitioners about how they deal with such an issue. And their findings made for interesting reading.

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Steven Pantilat, founding director of the University of California-San Francisco Medical Center’s Palliative Care Program, admitted, “This is not easy. Nobody likes doing it. No matter how well you deliver bad news, it’s still bad. You can’t make it somehow okay for the patient, but it’s important not to make it worse.”

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Dr. Pantilat referred to one particular patient he’d personally dealt with, an 89-year-old diagnosed with untreatable colon cancer. He said, “And now I have to tell him this terrible news. I told him in simple language, and then I was just quiet. We as physicians don’t always appreciate just how bad the news will be to someone who still thinks their tomorrows are infinite.”

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In his book Life After the Diagnosis: Expert Advice on Living Well with Serious Illness for Patients and Caregivers, Dr. Pantilat offered physicians some advice. He suggested not to complicate matters when it comes to delivering bad news, writing, “Don’t use jargon or euphemisms. It is what it is, and it has a name. Then give the patient some time to respond.”

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Dr. Pantilat also recommends only giving the most necessary of information at first. Some professionals can’t deal with awkward silences and bombard the patient or their families with details that they don’t take in. The medical professional believes that the best way to espouse any additional information is to set up a second meeting when any further questions can be asked and answered.

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Physicians delivering bad news should be also empathetic, according to Dr. Pantilat. But they shouldn’t try to bring their own experiences into the conversation. He wrote, “Don’t say, ‘I know how you’re feeling,’ or, ‘The same thing happened to one of my own family members.’” However, Dr. Pantilat stated it’s fine to say something along the lines of “I can see how devastating this news is for you. It must come as a big shock.”

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Dr. Pantilat also believes it’s fine to show emotion but not enough that it overshadows those of the person actually affected. He said, “If it’s a patient you’ve known for a long time, and you have to give bad news, and they start crying, you can cry with them. But my rule is I should not be so upset that the patient has to comfort me.”

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In a 2018 poll conducted by Sermo, nearly two thirds of the 1,076 physicians who took part claimed that their medical training didn’t adequately prepare them when it comes to delivering bad news. One answered, “We had one day of training on this and related subject. Four years of learning medicine and one day to learn compassion.”

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But there are also some schools which cover the matter more in-depth. Another medical professional replied, “I had the good fortune of studying at a university… where they gave us a class in the psychiatry module where they explained how to deliver bad news.” Apparently, this included lessons on reporting about a patient’s death or terminal illness.

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However, some insist that delivering such sad news is not a skill that can be taught. One physician told the Sermo study, “Frankly I do not know if you can teach something that depends largely on your personal predisposition to empathy and the path that each of us performs in their professional growth. I learned on my skin to handle difficult communication, probably at the cost of various errors and adjustments over time.”

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Others believe, meanwhile, that shadowing their more experienced fellow colleagues is the best way to learn. Another participant in the survey said, “Like many things, the first time is the hardest. If you have had good mentors, you at least have some frame of reference for what you should do and say.”

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However, palliative care physician Dr. Timothy Jessick believes that delivering bad news is a skill which can be acquired. Jessick, who works at Wisconsin’s Aurora West Allis Medical Center, has devised a four-hour training initiative which aims to improve communication between physicians and terminally ill patients. He told Medical News Today, “What we’re trying to do is help hospitalists change their mindsets to be more person and patient-centered.”

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And Dr. Jessick isn’t the only professional who’s placing more importance on the issue. Staff at Oregon Health & Science University now insist that all students must pass a compassionate communication test before being allowed to graduate. This involves owning up to medical errors, delivering bad news and demonstrating empathy in an ethical and effective manner.

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Such initiatives can’t come quick enough for some; in another Medscape Medical News survey, 51 percent of physicians admitted they’d put off giving patients bad news. A similar figure revealed that anxiety was a major issue when it came to the practice. Thirty-six percent had ended up feeling like they’d failed in their job and 32 percent were left frustrated.

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The study also revealed that several other factors come into play in terms of when and how professionals deliver bad news. These included time and space constraints, a breakdown in communication between staff and a vital lack of training. One commenter on the findings remarked, “Many effective approaches exist but they have to be more broadly incorporated into the curriculum. That would be a useful topic to include in [maintenance of certification] instead of observing colleagues wash their hands!”

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Another commenter added, “Honesty between doctor and patient shouldn’t be an option. Trust is essential. If I took deductions that could get me in hot water with the IRS I’d expect my accountant to advise me so. If I had a disease that could threaten my life I’d expect my doctor to tell me.”

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“I have found that most people want to know the results as soon as possible following diagnostic testing,” added an advanced practice nurse about the poll results. “Even with an initial emotional outburst they usually want to know more about any options for treatment and palliative care. I have never believed that withholding information from patients is within our right, especially when they have sought out our knowledge and capability to provide answers.”

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The subject was also addressed in a 2018 report published by the Royal College of Physicians in the U.K. “Talking About Dying” showed that medical professionals often avoid discussing bad news in detail as they feel unequipped to do so. Of course, this tactic can have devastating effects on the patient in question.

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This report stated that the likelihood of terminally ill patients receiving aggressive and largely unnecessary treatment towards their end of life increases if doctors avoid talking to them about their condition. These patients are also far more likely to pass away in an environment outside of their choosing. And this is a huge problem, because 80 percent of care home residents and one in three acute patients are expected to die within a year.

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“Talking About Dying” also found that doctors worried about getting their facts wrong. The particular length of time that a terminally ill patient had left was one of the biggest concerns considering the difficulty of making such predictions. Many doctors also assume that patients also want to avoid talking about death. However, the report stated that 77% of people would prefer to find out if they had less than 12 months to live.

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In 2015 Medicare announced plans that would give doctors an incentive to take on the responsibility of delivering bad news. The federal program would reimburse any medical professionals who engaged in an end-of-life conversation with patients. And the Centers for Medicare and Medicaid’s chief medical officer, Dr. Patrick Conway, believes that the idea is long overdue.

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“We think those discussions are an important part of patient- and family-centered care,” Conway told The New York Times in July 2015. He also revealed that there wouldn’t be a limit to the amount of reimbursed end-of-life talks. Conway added, “The reality is these conversations, their length can vary based on patients’ needs. Sometimes, they’re short conversations the person has thought about it. Sometimes, they’re a much longer conversation. Sometimes, they’re a series of conversations.”

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Of course, there are many doctors who are able to approach such a difficult subject matter with aplomb. One such professional is Dr. Louis M. Profeta, the emergency physician at Indianapolis’ St. Vincent Hospital who we mentioned earlier. And in a heartfelt post he published on LinkedIn, Profeta proved that he goes above and beyond when it comes to informing a family about a young person’s avoidable death.

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In a piece titled “I’ll Look at Your Facebook Profile Before I Tell Your Mother You’re Dead,” Profeta explained why he trawls through a deceased patient’s social media in preparation for delivering the tragic news. And in a novel approach, he addressed his words to the victim rather than the parents. Unsurprisingly, it all makes for highly emotional reading.

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“It kind of keeps me human,” Profeta began. “You see, I’m about to change their lives your mom and dad, that is. In about five minutes, they will never be the same, they will never be happy again.” It’s a dramatic statement which undoubtedly packs a punch. And it’s followed by a matter-of-fact remark which underlines how much death is part and parcel of a doctor’s job.

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Profeta continued, “Right now, to be honest, you’re just a nameless dead body that feels like a wet bag of newspapers that we have been pounding on, sticking IV lines and tubes and needles in, trying desperately to save you. There’s no motion, no life. Nothing to tell me you once had dreams or aspirations.”

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However, Profeta makes it his mission to ensure he’s fully aware of the deceased’s dreams and aspirations. He went on to explain, “I owe it to them to learn just a bit about you before I go in. Because right now… all I am is mad at you, for what you did to yourself and what you are about to do to them. I know nothing about you. I owe it to your mom to peek inside of your once-living world.”

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“Maybe you were texting instead of watching the road, or you were drunk when you should have Ubered?” Profeta wondered about the cause of the victim’s death. “Perhaps you snorted heroin or Xanax for the first time or a line of coke, tried meth or popped a Vicodin at the campus party and did a couple shots.”

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Profeta then continued to list the kind of scenarios that may have resulted in a youngster’s death. He wrote, “Maybe you just rode your bike without a helmet or didn’t heed your parents’ warning when they asked you not to hang out with that ‘friend,’ or to be more cautious when coming to a four-way stop. Maybe you just gave up. Maybe it was just your time, but chances are… it wasn’t.”

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Whereas some doctors shy away from any details that may heighten their emotions, Profeta prefers to learn as much about the deceased as possible. In the LinkedIn article, he explained, “So I pick up your faded picture of your driver’s license and click on my iPhone, flip to Facebook and search your name. Chances are we’ll have one mutual friend somewhere. I know a lot of people.”

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Profeta continued, “I see you wearing the same necklace and earrings that now sit in a specimen cup on the counter, the same ball cap or jacket that has been split open with trauma scissors and pulled under the backboard, the lining stained with blood. Looks like you were wearing it to the U2 concert. I heard it was great.”

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Further expanding on the type of material he finds while perusing the deceased’s social media, Profeta added, “I see your smile, how it should be, the color of eyes when they are filled with life. Your time on the beach, blowing out candles, Christmas at grandma’s; oh you have a Maltese, too. I see that.”

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And Profeta’s post becomes more emotional the further down you read. He added, “I see you standing with your mom and dad in front of the sign to your college. Good, I’ll know exactly who they are when I walk into the room. It makes it that much easier for me, one less question I need to ask.”

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“You’re kind of lucky that you don’t have to see it,” Profeta added to the person who has lost their life. “Dad screaming your name over and over. Mom pulling her hair out, curled up on the floor with her hand over her head as if she’s trying to protect herself from unseen blows.”

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Profeta then dramatically concluded his piece. He continued, “I check your Facebook page before I tell them you’re dead because it reminds me that I am talking about a person, someone they love. It quiets the voice in my head that is screaming at you right now shouting, ‘You mother f***er, how could you do this to them, to people you are supposed to love!’”

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Understandably, Profeta’s moving piece inspired a whole host of supportive comments. One LinkedIn user replied, One LinkedIn user replied, “Thank you for your words, your compassion and sobering insights to a terrible situation.” Another responded, “What makes him spectacular is not only saving lives, but looking beyond the death to understand the person on the table.”

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Despite the difficulties of the job, Profeta told Medium that being an emergency physician is an “incredible privilege.” He added, “Dealing with people’s lives is the beauty of medicine. It is the reason why people choose this profession. Obviously, when you’re dealing with the tragedy you have to separate yourself from it. You have to have a warm home in a welcoming environment to come back to after the day is done. I am blessed to have that.”

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