Living With Dying articles

We asked Dr. Lakin about how, with such a varied background, he ended up specializing in palliative care. His answer has a lot to tell us about how doctors are trained.

Here is our conversation (edited for length and clarity).

Leah Carey: Did you get any training in med school about death?

Joshua Lakin: No. Not that I remember. I got a lot in residency.

LC: That seems like a huge hole.

JL: It’s a huge hole. The students that I’m working with now at Harvard, they get more training in this. But it still is a hole. I guess the challenge is, when is the right time? And I still don’t know the answer to this.

Is it early in med school before you’ve had a chance to see what the clinical world is like and what disease is like? Or is it during residency when you are in it and watching it and experiencing it?

Probably intern year, or first year of clinical training. Or late in medical school, to get people an experience with that process. Because it’s a normal experience for most clinicians, they’re going to be treating people who are going through the dying process.

For me, residency was the right time.

LC: What was your training in residency like?

JL: I got a lot of teaching from the palliative care team about how to talk about death, what normal death looks like. How to sit with the family with it. And this was even before my fellowship training. So I was comfortable going into the room with a dying patient by the end of my residency, and sitting with them and talking with them, and assessing what was happening with that person in terms of their dying process and telling the family what I saw, what was going on.

We have medical students who rotate through our palliative care unit in Boston, which is great. At the University of California at San Francisco where I trained, the palliative care rotation was the most popular medical student rotation.

LC: Why was it so popular?

JL: Your initial clinical years in medical school are just a trip. You go from very heavy reading and studying and test taking, and then all of a sudden you get thrown into this world that is just crazy in its intensity and its vulnerability. You just go in there and you’re supposed to keep learning, but you bear witness to a lot of suffering. I think it sings to them after all they’ve seen.

So to get a rotation that is essentially focused on suffering and trying to find ways to relieve that, my guess is that it spoke to some of the stresses they were experiencing. It gave them some tools in dealing with it themselves, and also dealing with it with their patients.