Most surgical residents feel unprepared to discuss death or deliver bad news to patients.

Addressing death openly is becoming more accepted in surgery, but education lags behind culture shifts.

Quality of life, not just survival, should guide care decisions in serious illnesses.

Have you ever had to tell someone that they are dying?

For me, the first patient I recall was a 20-year-old woman, who was the first clinic patient I saw as an Immunotherapy and Surgical Oncology Fellow at the National Cancer Institute over 16 years ago. She was being treated for metastatic melanoma, and the disease had returned and spread to her brain. My job as the doctor was to deliver this news and to tell her that there were no more treatment options available. I was 29 at the time, and in no way prepared to deliver such devastating news, especially to someone who was so near my own age. I saw myself in her and began to contemplate my own mortality, and what it would mean if I were the one on the receiving end of such news.

As a surgeon, I, along with my colleagues, am trained over a five-year or more period (with additional years added on for fellowships) to determine the differential of disease processes, and how to best help — to cut or not to cut. And while delivering bad news is felt to be a part of surgical residency training, studies have shown that residents do not feel competent in doing so. One study found that less than half (46%) of........

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