Saying goodbye: Seeing a patient just admitted to hospice care

It’s Friday afternoon and I check the day’s schedule. A name jumps out at me and I groan a little and worry — what am I going to say to someone I’ve treated for twenty years, who’s my age and just been admitted to hospice care? If this is goodbye, how do I as a physician, who is more than an acquaintance but not quite a friend, handle this appointment?

All kinds of things go through my head. Do I really want to charge for this? How bad will he look? Can I keep from crying? Is there anything I can do for him anyway? Will I ask the right questions? Will I say the right things?

He comes with a relative. He is living alone but they have found a nursing home that he liked today and he hopes to transition there quickly. He has one sorrow and one fear. He needs to find a home for his dog of 14 years. He shows me a picture of a cute lap dog of some sort. Amazingly, during his last hospital stay he met someone who is willing to take care of the dog. His fear is how breathless he will be near the end. I reassure him that every effort will be made to make him comfortable and he should not suffer.

We talk a little about his parents, with whom he has been estranged for some time. He assures me that he has spoken with them. They are older and have had their own medical challenges. I cannot imagine how they feel. He jokes a little about his relationship with them.

Finally it is time for him to go. He looks tired, but not that ill. He asks me if he should try to eat, he doesn’t have much appetite, and I encourage him to eat whatever he wants. He stands up and gives me a hug, whispering “I love you” in my ear as he does. After reminding me that the phone is a good method of communication, he leaves.

I am lost in thought and emotion but still have two more patients to see. I take a breath, walk into the next room and apologize for my tardiness. It’s probably obvious that I’m upset but the rhythm of seeing patients takes over and, somehow, reassures me.

Kathy Nieder is a family physician who blogs at Family Practice 2.0.

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  • Pamela Ressler

    I find it sad and disturbing that our health care system does not value continuing the patient/provider relationship built through years (20 years in this case) as a patient transitions from the acute care model to hospice care because of an obsolete model of payment (a new team of providers takes over care). Perhaps I am tilting at windmills, but wouldn’t it be wonderful if we could foster the relationship built with our patients and practitioners through all phases of care?

    • Joe

      With hospice the physician has the option to remain as the attending

      • http://twitter.com/docnieder Kathy Nieder MD

        I briefly remained as attending but without my knowledge the Nursing Home doctor took over his care and I was not notified of his death for a couple weeks, very upsetting.

  • Joe

    In hospice the doc that this patient has seen for “20 years
    ” has the option to remain as the attending physician and be very involved with the care of the patient (along with the input of the hospice physician). Also, hospice pays for an occasional doctors office visit as well to keep the patient connected to the physician that he or she has grown to love. I hope this helps!

  • Suzi Q 38

    This is very good information for us, thank you.
    Whenever our loved one is placed somewhere else, we think that our regular doctor can no longer see them. If we brought the relative home for hospice, could our PCP MD come to our home?

  • SBornfeld

    +1

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