Doctor writes guide for discussing COVID-19 with patients

Postscript

April 2, 2020

Doctor writes guide for discussing COVID-19 with patients

"This is about how to talk in the era of crisis-care standards," says author Anthony Back, a UW Medicine oncologist and palliative-care specialist. 

Communication between patients and caregivers has long fascinated Dr. Anthony Back, an oncologist and palliative-care specialist at UW Medicine in Seattle. A few weeks ago, he realized that clinicians should have specific guidance for talking about coronavirus – especially now that the pandemic has taken hold in the United States and physicians are talking about rationing ventilators and other critically needed supplies. 

“I was talking with Vicki Sakata of the Northwest Healthcare Response Network and psychologist Tona McGuire, who's had a lot of experience in disaster areas like Katrina and Haiti," Back said. “And I realized that communication about this disaster has a whole other layer beyond typical serious illness. Because if we start talking about rationing, we’re right back to having to deal with ‘death panel’ suggestions again. And we will lose patients' trust at a time when we must have it.”

So he took the initiative and published a Google Doc on COVID-Ready Communication Skills, and it went viral. "It's been translated into 14 languages already," Back said in astonishment. He was contacted by the Annals of Internal Medicine and asked to write a commentary. "Communication Skills in the Age of COVID-19" was published today. 

“This is about how to talk in the era of crisis-care standards. It's super scary what caregivers are up against. We've never experienced anything like this,” Back said.

The essay is not all about clinician-patient communication; two sections toward the end of the guide, called "Anticipating" and "Grieving," are directed at physicians' self-care. 

“If you look at physicians who've been first responders in other disasters – 9/11, Vietnam, Katrina – it's very clear that there are substantial psychological consequences. One is moral distress, this feeling of knowing the right thing to do but being unable to do it, which is associated with burnout and depression,” Back said.

“As we work our way through this, the physician community really needs to take care of each other and ourselves," he said, identifying empathy and earnest listening as priority skills to maintain. “We have to pay attention to this now.”