A Good "Bye" Before Hospice

Why would oncologists (or any physicians) not say "good-bye" when they know this is the last office visit for a patient before being transferred to hospice care?

The transition from active treatment to hospice care is fraught with intense emotions and dashed hopes on both sides of the stethoscope:

• Many patients believe "hospice" and "hope for recovery" are mutually exclusive.
• Many physicians believe "hospice" and "hope to help patients heal" are mutually exclusive.

Physicians may feel tongue-tied when they transfer their patients' care to hospice:

"[F]inal good-byes...dramatize the limits of physicians' abilities to cure. Some physicians equate saying "good-bye" with admitting defeat. Others...avoid "good-bye" so as not to risk extinguishing patients' hope." (excerpted from Only 10 Seconds to Care, p.157)

As a Healthy Survivor, try to keep in mind that this transition is difficult for many physicians. Although it is not your job to help your clinicians, if you feel like it you can say something like, "What a journey together. I won't miss the treatments, but I will miss coming to the office and seeing you and your staff. We did our best. My family and I will always be grateful for your care."

Click here to read "Final Good-byes"

Comments

[richard frank]

Dear Wendy,

These are very important topics and your compassion for oncologists is most welcome!

As one of those oncologists, I'll add a couple of thoughts.

When I do recommend no further therapy and hospice care to a patient/family, I add them to a little list I keep on my desk. The list is not titled but I know it means "don't forget about these patients." I call them once every week or two and speak with them or leave a message if no one answers just to let them know they are not forgotten.

When it is clear in my office that a patient will die soon, that our present encounter will be our last, I have found that the patient will often say good-bye and thank-you and I will do the same; we will often embrace and it is very hard and poignant.

This conversation is so difficult to initiate and guide in a compassionate and clear manner. But, that is the role of the oncologist, one of our most important without a doubt.

Rich Frank

[Wendy S. Harpham, MD]

Dear Dr. Frank,

Thank you for taking the time from your busy practice to share your experience here and give patients a peek into your world as a clinician.

I, too, had my "list" on my desk, but as an internist I did not have near the number of "good-byes" as you surely do.

In many cases doing something difficult gets easier with repetition. Not so when it comes to saying good-bye to patients.

So I appreciate that you continue to show compassion, knowing when it comes to saying good-bye it won't be easy.

With respect and hope, Wendy

[Jeanne M Hannah]

Wendy, I'm not sure this comment belongs here, but I'd like to share an experience about hope.

I am lucky to have "another mother," a delightful lady now 97 who has been a second mom to me for 30 years. She's been in the hospital this past week after a fall that either was caused by or that precipitated "a little heart attack."

She explained that her care is supervised by a hospitalist, not her usual internist. She said that she told him about 3 days after admission that she was tired, really tired, and she thought it was time to give up.

He spent 30 minutes with her. He asked her about her family. She lives independently and has three wonderful children who take of excellent care of her whenever she needs care. He asked about her friends and her interests. She has many. They had a good long talk and then, she said, the doctor said, "You know this was just a little heart attack. You've got a lot of good things going for you and I think I can get you at least another three years."

It meant so much to her to have this conversation with the doctor. It gave her hope and it gave her courage. She is feeling much better and will be going home tomorrow!

So I can look forward to fulfilling my Christmas gift to her: lots and lots of containers of various interesting soups delivered to her home for her to freeze and have whenever she wants an easy, healthful meal.