TIME Cancer

What Doctors Should Say When Patients Want a Miracle

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A new tool teaches doctors how to talk to patients about miracles

Many doctors, when delivering difficult news, have heard sick patients say they’re hoping for a miracle. That conversation can be difficult for physicians, whose careers are grounded in science—but who are also in the business of saving lives. While “miracles” may seem a silly thing to wish for, a 2008 study, 57% of randomly surveyed adults said they believed God’s intervention could save a family member even if physicians declared treatment futile.

In order to help doctors navigate this common situation, a team of physicians at Johns Hopkins Kimmel Cancer Center have created a helpful conversational tool called AMEN (affirm, meet, educate, no matter what), recently published in the Journal of Oncology Practice. AMEN is meant to teach doctors an alternative to either challenging the patient’s beliefs, remaining silent or changing the subject when conversations take a turn. Instead, it gives physicians a tool to affirm hope while keeping intact their role as the provider of accurate medical information. Here’s what it stands for:

  • Affirm the patient’s belief. Validate his or her position: “Ms X, I am hopeful, too.”
  • Meet the patient or family member where they are: “I join you in hoping (or praying) for a miracle.”
  • Educate from your role as a medical provider: “And I want to speak to you about some medical issues.”
  • No matter what, assure the patient and family you are committed to them: “No matter what happens, I will be with you every step of the way.”

“I use the AMEN mnemonic pretty much every day. Maybe my patients need more miracles than other doctors’ patients, but it is a common occurrence and an underlying theme in many people’s lives,” says Dr. Thomas Smith, the director of palliative medicine at Johns Hopkins.

“The heart of the AMEN protocol is the commitment to joining rather than placing more distance between patient and provider,” the authors write.

They recommend that when patients say they are hoping for a miracle, doctors say something along the lines of “It is God’s role to bring the miracle, and it is my role as your physician (or nurse) to bring you some important information that may help us in our decision making.”

Restoring and maintaining hope, the authors say, is one of their responsibilities—and learning how to navigate that is critical to patient-doctor relationships.

 

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