{"podcast":{"title":"Sensible Medicine","slug":"sensible-medicine-5998897","podcast_index_feed_id":5998897,"rss_url":"https://api.substack.com/feed/podcast/1000397.rss","website_url":"https://www.sensible-med.com/podcast","image_url":"https://substackcdn.com/feed/podcast/1000397/42e130301a7b8cf1be4b562c83e7206b.jpg","author":"Sensible Medicine Authors and Editors","episode_count":131,"summary":"Common sense and original thinking in bio-medicine","last_synced_at":"2026-06-26T18:18:33.235478+00:00","page_url":"https://stenobird.com/podcast/sensible-medicine-5998897"},"episode":{"title":"Friday Reflection 62: The Ethics of Telling Patients We Have Nothing Left to Offer","slug":"friday-reflection-62-the-ethics-of-telling-patients-we-have-nothing-left-to-offer","published_at":"2026-06-26T09:00:00+00:00","page_url":"https://stenobird.com/podcast/sensible-medicine-5998897/friday-reflection-62-the-ethics-of-telling-patients-we-have-nothing-left-to-offer","show_page_url":"https://stenobird.com/podcast/sensible-medicine-5998897","url":"https://www.sensible-med.com/p/friday-reflection-61-the-ethics-of","audio_url":"https://api.substack.com/feed/podcast/200930816/a37afc0edc328e8c37b5e8d5cd228472.mp3","summary":"TR is an 88-year-old man who is disabled and in chronic pain from spinal stenosis and knee osteoarthritis. He has multiple other medical issues, including coronary artery disease and COPD. He has been through years of treatment for his knees and back, including physical therapy, multiple joint injections, and an in-office procedure for spinal stenosis. He has been on multiple regimens of oral pain medications. He is not interested in surgery (and probably would not be considered a reasonable candidate if he were). He comes to a visit and asks what can be done. Sensible Medicine is a reader-supported Substack. If you appreciate our work, consider becoming a free or paid subscriber. We are taught never to say, “There is nothing I can do for you.” We may be out of surgical or medical options, but we can always continue to care for and support our patients. This is not part of the Hippocratic Oath , but it is so integral to our training that one might think it belongs there. There are good reasons to caution doctors from saying some version of, “I am sorry, I don’t think there is anything more I can do for you.” It is true that in 21st-century medicine, the act of caring for patients has been so trivialized that we need to remind ourselves that caring is not just a last resort but our first responsibility. Hope in the face of illness is exceedingly valuable. Robbing this hope is not only cruel, but probably bad for the health of patients. Then there is the truth that when one doctor has nothing left to offer, medicine often still has more to offer. I am still haunted by at least one case when I mistook my lack of knowledge for a shortcoming in the field. A doctor saying he has nothing left to offer may be taking the easy way out. Further research or a considered referral o…","meta_description":"TR is an 88-year-old man who is disabled and in chronic pain from spinal stenosis and knee osteoarthritis. He has multiple other medical issues, including…","key_points":[],"chapters":[],"topics":[],"duration_seconds":297,"processing_state":"not_requested","actions":[{"name":"request_transcript","method":"POST","url":"https://stenobird.com/v1/public/podcasts/sensible-medicine-5998897/episodes/friday-reflection-62-the-ethics-of-telling-patients-we-have-nothing-left-to-offer/transcription-requests","description":"Idempotently request low-priority transcript generation for this episode."},{"name":"read_markdown","method":"GET","url":"https://stenobird.com/podcast/sensible-medicine-5998897/friday-reflection-62-the-ethics-of-telling-patients-we-have-nothing-left-to-offer.md","description":"Read the agent-friendly Markdown representation of this episode resource."}]}}