For many physicians, having serious illness conversations with patients — talking about a dire prognosis or the futility of curative treatments — is one of the most daunting aspects of patient care. But to palliative care physician Shunichi Nakagawa, MD, these conversations are fundamentally about communicating the honest truth in an elegant, considerate, and humane way. 

Dr. Nakagawa, the director of the Inpatient Palliative Care Service at Columbia University Medical Center, joins us in this episode to discuss both his unique personal journey, as well as his insightful approach to figuring out what really matters to patients during critical moments in their lives. He shares what it was like completing his surgical training in Japan, than coming to the United States with the hope of becoming a liver transplant surgeon, before having those hopes dashed when he found out he was ineligible to work as a surgeon in the US due to his hepatitis carrier status, and finally discovering his true calling in geriatrics and palliative care. 

We also discuss cultural challenges in thinking about the end of life, why it is so difficult for physicians to communicate with their patients about serious illness, how clinicians ought to approach shared decision making, and why, when done well, this can be one of the most meaningful and rewarding parts of doctoring.

In this episode, you’ll hear about: 

2:34 - How Dr. Nakagawa entered a career in medicine in Japan

5:33 - Dr. Nakagawa’s unique journey through medical training, from surgery to palliative care  

16:25 - The three-stage process that Dr. Nakagawa follows when communicating challenging medical information to patients

28:10 - Delivering medical advice in a succinct way when speaking to patients and their family members 

36:14 - Lessons on what works and what doesn’t work in sensitive patient communication 

Dr. Shunichi Nakagawa can be found on Twitter/X at @snakagawa_md. 

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