Abandoned to Hospice?

Denise commented on yesterday's post "I would feel badly if my oncologist referred me to hospice, he said goodbye, and I had no further contact with him..." Is it unrealistic to expect oncologists to stay involved with patients who are now in hospice?

Oncologists guide patients through difficult decisions and challenging treatments over many months or years. Saying good-bye forever can be wrenching for the patient. And for the physician. Does it have to be this way? 

Since the hospice team is trained to handle everything that might come up in the care of patients at the end of life, the long-time oncologist's expertise is rarely needed. But I suspect Denise is also talking about the oncologist still caring about the patient. To be cut off from all contact can feel like being abandoned to hospice.

Oncologists who work unduly long hours caring for patients in active treatment may find it difficult to find time to keep contact with all their patients in hospice. So here is a suggestion to Healthy Survivors who want to stay connected: Leave a message or drop a note to your oncologists to let them know how things are going.   

And don't take it personally if you don't hear back. Compassionate oncologists may struggle with how to relate to patients when they are no longer trying to manage or cure the disease. In my next post I'll explore why caring oncologists might not even say "good-bye" when they know it is the final visit. 

Comments

[Tyra]

Losing contact with my husband's oncologist was painful --even though I understand the reasons why. Almost seven months after Steve's passing, I still miss hearing from Dr. M, partly because she was such a huge part of our lives and hope for the future and because she's a genuinely compassionate soul.

[Wendy S. Harpham, MD]

Dear Tyra,

Your family was fortunate to have the expert and compassionate care of Steve's oncologist through the many months of his illness, as you described on your blog.

Your postings since Steve's death have been a testament to the notion that after a loved one dies, the relationship continues on (just in a very different form). You continue to feel Steve's love.

So, too, the physician-patient/family relationship can live on, just in a different form.

Dr. M's efforts to help Steve be all he could be for as long as possible set the stage for Steve's memory being a force for good after Steve's death.

The hope you shared with Dr. M. for a cure -- and then the hope for some more days together on earth -- is now gone. A new hope has taken center stage: Embracing the memory of Steve in ways that bring strength and joy, instead of causing nothing but sadness. This is a powerful hope.

I don't know Dr. M. But from what you've written,I'm confident she would be grateful for updates about you and the children. The pictures and updates tell a story of shared hopes being fulfilled.

With hope, Wendy

[Judy Dobson]

This is what I teach to others on hospice teams. When the patient is admitted to hospice, they are to continue their follow-up visits to their attending physician as long as possible. Once it becomes a burden to the patient and they begin to enter the last stage of the disease process, I encourage staff to offer the patient/family to communicate by phone to the physician who has cared for them so well. It may be more than one. A phone call to the department secretary to ask the physician to call back, or if the Dr. is not able, to leave a message of thanks, will go a long way. It also provides a sense of "closure" perhaps for the attending.
I also encourage the case managers of the patients to write a personal note to the attending, stating that the patient expired and perhaps a few words about the status at that time...e.g. the family was in attendance, or the patient died peacefully in a facility...whatever the situation. And then a "thank you" for directing the care of this patient. Finishing up "last things" helps all providers, I believe....