Dr. David Tribble

A USA Today article recently cited a study indicating that terminally ill patients often feel abandoned by their attending physicians after entering end-of-life care. It is a sad thing that patients feel abandoned when they are most vulnerable. To be fair, this is probably not so much a manifestation of disinterest on the part of physicians as it is misunderstanding or discomfort with hospice. Even before my 17-year career with hospice began, I cared for terminally ill patients in my family medicine practice, largely because their usual physicians had become uncomfortable with caring for them.

The statement that “there is nothing more we can do” belies the common belief that there is no acceptable outcome other than cure. The fact is, there is a lot left to do, once we know that a patient cannot be cured. We can maintain function, comfort, and purpose, and when it is time to die, death can be managed with dignity and comfort.

It is likely that many physicians find managing pain and other unpleasant symptoms foreign ground. This does require a special skill set. But, like any skill, this can be learned and most palliative care physicians are willing teachers.

Many physicians and patients view death as the failure of medicine. Avoidable death should, indeed, be avoided, but there is a time for all of us when death is the natural course of things. American culture is generally death-denying, and it should not surprise us that physicians, raised in that culture, also deny death. Perhaps it is time for us to stop expecting immortality.

Entering hospice care doesn’t mean that the patient’s relationship with his or her attending physician has to end. By its very design, hospice care includes the patient’s physician as part of the treatment team. The hospice staff has fewer time constraints than does the attending physician, which allows the hospice staff to be the eyes and ears for the physician, but there is nothing about hospice care that prevents or even discourages patients from keeping appointments with their physicians while they can.

The hospice care plan is reviewed and approved by the patient’s attending physician on a regular basis. Many physicians find home visits difficult to fit into their schedules, but there is nothing to prevent a phone call. Whether or not the physician remains involved is a matter of choice, and staying involved is a needed prescription.