Book Reviews

It's Never Easy: The Terminal Diagnosis Book Review by Vincent J Felitti, MD

This teaching videotape opens with a line that will resonate with most of us: "Medical school only prepared me for about half of what I experience daily."¹ The words are spoken by a young physician who has just diagnosed a friend with a fatal illness.

This story line is the basis of this continuing medical education (CME) videotape, which is so well made that we can be proud it is produced in-house at Kaiser Permanente (KP). Moreover, the actors are our own in-house CareActors troupe, which supports educational training for SCPMG and TPMG via live theatrical productions as well as video. How many medical groups have an actors' troupe on staff? And what is the role of the arts in treating illness (as opposed to treating disease)? Although the original version of this program about coping with fatal illness was created by the KP Ohio Region, the current, revised version was developed by a nationwide KP committee. I hope they extend their work into other problem areas of clinical practice.

The videotape is divided into three segments, each depicting a major problem in practice: 1) delivering bad news, 2) coping with difficult emotions, and 3) end-of-life care and follow-up. The accompanying Facilitator's Guide is designed to stimulate meaningful group discussion among caregivers who view the tape. Of course, the tape can be viewed individually, but the questions posed at the three nodal points make it clear that we all would benefit from hearing the opinions of others on these difficult and conflictual matters.

It's Never Easy is an excellent prototype for thinking about the way we deal with life-threatening illness or with the complexities of disagreement within a patient's family. The tape realistically shows disagreement, passivity, anger, and agitation in family members and shows physicians not anticipating having to treat a whole family; physicians being kind; physicians being socially inept; and physicians facing hostility. The questions provided in the Facilitators' Guide help us explore our own emotions, the emotions of patients and their families, and the difficult problem of conveying information when denial fills the air. The tape closes by discussing the task of helping a patient live as well as possible when faced with the actuality of dying.

At a purchase price of six dollars, this videotape has got to be the best medical education buy of the year! After all, who was taught about this most-important topic in medical school? We can all be proud that this program originated as part of the Kaiser Permanente Endowed Lectureship in Bioethics at Case Western Reserve School of Medicine, where the tape was used to advance bioethical discussion among health professionals in the community.

Videocassette. Producer: JoAnn Lesser. Los Angeles: KP MultiMedia Communications; 1999. $6 with instruction guides.

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