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    Teaching End-of-Life Care

    A Q&A with Matthew Ellman, MD

    By Mahima Samraik, MS
    7 Minute Read

    Every year, thousands of families sit in hospital rooms hearing words no one wants to hear: “We have done everything we can.” What happens next, whether doctors stay engaged or step away, can transform one of life's most difficult moments for patients and their families.

    Unfortunately, for too many patients, the shift from curative care to end-of-life care leaves them feeling stranded. Physicians, trained to fight disease and save lives, can struggle when those tools no longer work. Some retreat behind clinical distance. Others hand off care entirely, leaving many families to navigate their most vulnerable moments without the support of the physicians they know.

    “But it doesn't have to be this way,” says Matthew Ellman, MD, professor of medicine (general medicine) at Yale School of Medicine (YSM) and director of Medical Student Palliative and End-of-Life Care Education. “In my experience, patients want clinicians who will be there for them even when cures or life-prolonging treatments are no longer available, and that's a huge part of patient care.”

    Ellman has spent decades at patients' bedsides and now teaches medical students about death and dying. In his recent essay in Academic Medicine, he draws from his personal experiences as a physician and encourages fellow doctors to embrace difficult conversations around end-of-life care.

    We talked with Ellman about the importance of human connection in end-of-life care and how YSM is empowering the next generation of physicians to be actively present when their patients need them the most.

    Your essay takes a deeply personal approach to discussing death and dying throughout your career. What prompted you to write it now?

    Matthew Ellman: I've been reflecting on these concepts for a while, looking back on my own trajectory and realizing that my colleagues, both in patient care and education, have tremendous wisdom to offer in end-of-life care. Many physicians don't think about teaching in this area because they assume you need to be a hospice or palliative care specialist. But through teaching Yale medical students and working with colleagues, I realised many clinicians across specialties have valuable insights from years of caring for dying patients.

    While I deeply respect my hospice and palliative medicine colleagues and I always learn from them when we co-teach, I see students and young doctors working alongside physicians from all specialties who also have important experiences to share. So, you can say the motivation was twofold—personally reflecting on my career at this stage of life and hoping to inspire other physicians to recognize what they can contribute to teaching about end-of-life care.

    How important is human connection in the work that you do?

    Ellman: Having a human connection gets to the heart of end-of-life care and our work. As a primary care doctor, I have relationships with patients that last decades, which is why I chose this field. I care deeply about my patients, both medically and as whole people, which includes emotional aspects of care. But if you close yourself off from the harder emotions in patient care, over time, you become closed off to all emotions, including the good ones.

    That's why physicians and nurses need their own practice of reflection and processing emotions to avoid burnout and maintain a connection with patients. Many students worry about getting emotional in front of a patient. I tell them, patients don't want robot doctors; they want someone who cares about them as human beings.

    It's okay to show emotion when patients are suffering. You need healthy boundaries since patients aren't friends or family, but completely shutting down emotionally is the worst approach.

    How can doctors approach end-of-life patients differently?

    Ellman: When patients realise that they are near the end of their life, many common fears emerge—being a burden to family, suffering or pain, being treated differently by loved ones, or just being abandoned by their doctors. Unfortunately, for some, that last fear often becomes reality.

    Many physicians do pull back when curative options are exhausted, sometimes from feelings of failure, reminders of their own mortality, or simply being too busy to focus on a patient they can't "fix." But patients, especially those with long-standing relationships with their doctors, deeply appreciate it when physicians stay involved even without active treatments.

    The shift in approach, I believe, is freeing and liberating for doctors. Instead of focusing on lab tests and treatments, you're focusing on comfort, meaning, and presence. End-of-life care can become an incredibly rich, even sacred time for both patients and the doctors. It is when everything unimportant fades away and what truly matters comes into focus.

    You direct YSM's palliative and end-of-life care education program. What does that curriculum look like?

    Ellman: I started working on this nearly 20 years ago because I realised I never learned about caring for dying patients in medical school, as it just wasn't part of the curriculum. I had to learn on the job as a young doctor. So, my goal became to ensure every Yale medical student graduates with basic skills and comfort in end-of-life care, regardless of their future specialty.

    I see this as a core skill of doctoring, like learning to communicate effectively with patients. The curriculum, which has been around for 18 years, had to be experiential—you just can't learn this from lectures alone. Students need to engage with patients under guidance. We built it piece by piece over several years, integrating throughout all four years of medical school.

    For example, in the third year, I assign every student to identify at least one patient they're caring for who's facing end-of-life. Students learn to open conversations by asking "What are you thinking about for the future?" or "What worries you?" Many patients are grateful someone finally brings it up. Students then write reflective reports about these experiences.

    We also have students work with hospices, use simulated patient encounters, and learn advanced skills like death pronouncement and family notification. The curriculum involves about 50 faculty members working in small groups—you need that intimate setting for meaningful learning. We were able to prove the curriculum's effectiveness through student surveys and clinical exams. It's been incredibly gratifying to see faculty volunteer their time because they believe this teaching is so important.

    What prompted you to become a doctor?

    Ellman: I was drawn to both the sciences and caring professions—I knew I wanted to work with people. I was an anthropology major in college while doing my pre-med courses, so I've always been attracted to both the science of medicine and its humanistic side. I tried lab research briefly after college, working in a cancer virus lab, but I missed interacting with people. The combination of helping others through clinical science and teaching really appealed to me, and I’m grateful I ended up here at Yale.

    What's your hope for the future of palliative care and your message to future doctors?

    Ellman: The palliative care specialists I work with are outstanding, but there will never be enough of them—the mortality rate is one per person forever. My hope is to see physicians across all specialties see end-of-life care as part of their job. I know how much it matters to patients and how gratifying it can be. Compared to when I was in medical school, when nobody talked about it, I now see colleagues in many specialties viewing this as important work, and students who are eager to learn these skills. I'm hopeful for the future, and for life!

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    Mahima Samraik, MS
    Science Writer Intern, Office of Communications

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