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Allen R. Last, MD, MPH

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The recent article by Back et al¹ provides insight into the efficacy of an intensive physician training program to increase communication skills regarding end-of-life care and delivery of bad news, two of the more complex, daunting, and gratifying tasks that physicians perform on a regular basis. While I applaud their efforts to develop this program and assess its value, 2 things are troubling.

First, this is a stinging indictment of current physicians' communication skills. As one of many examples from their data, prior to the intervention only 16% of oncology fellows mentioned the word "cancer" to their patients with cancer. This is terrible by any standard. What is worse is that these fellows were selected "based on interest in communication as expressed in a brief personal statement, potential as an educator, and research in communication,"^1(p454) essentially a group already predisposed to doing this "well"!

Second, . . . [Full Text of this Article]

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RELATED LETTER

A Partial Solution to a Big Problem—Reply
Anthony Back, Robert Arnold, and James Tulsky
Arch Intern Med. 2007;167(20):2262.
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