One of the hardest things for me as a doctor to to tell the patient and family that there is no more active treatment available. The simplest thing is usually to keep giving some treatment or the other. The harder thing is to say NO.
For most patients and their families - ongoing treatment means ongoing hope (however small it may be). When we say no, we are dashing that hope.
There are ways to dilly dally with words and talk about best supportive care and symptom management and stuff like that.
Hard decisions. Hard implementation.
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