Eventually we'll all face death. Not something we want to think about or ruminate over but it's something that'll happen to all of us. Some of us will have no time to make plans or say goodbye and others will face long illnesses that culminate in hospice care.
What exactly is hospice care?
In lay man's terms it's a place people go to die, in a semi-medical setting. No life sustaining care is given - the patients are terminal and usually have several weeks to several months left to live. Pain management is administered and spiritual and social needs are met. Families are encouraged to visit regularly but aside from food and general needs, pain management is the only 'medical' intervention used. One out of every three terminally ill patients in America choose hospice care.
The vast majority of doctors end their relationship with their patients once the patient enters hospice and many believe that this causes much distress to the patient and their family members. Feelings of abandonment are common, even though it's commonly known that no further medical care can help the patient.
A new study has shown that not only did the patient and families benefit from continued contact with doctors but the doctors did too. Researchers at the Fred Hutchinson Cancer Research Center in Seattle asked doctors, patients and family members to chart the journey from medical care to hospice and the changing doctor-patient relationship that ensued.
Researchers found that families and patients appreciated the continued care of doctors, even if that care consisted merely of an occasional phone call to see how everyone was doing. And doctors reported these phone calls and continued care gave them a sense of 'closure' and appreciation of the death process - and area where doctors are under-trained in or not trained at all.
Patients and families reported that when all communication with their doctors ended upon the end of actual medical intervention, they felt 'abandoned' by their caregivers, despite the fact that there was nothing more a doctor could do. Doctors who did not continue communication were unsure of how to continue due to the new status of the patient's health and were unsure that patients would benefit from continued contact.
But patients and families generally maintained that continued contact was highly beneficial.
The full results of this study can be found in Archives of Internal Medicine.
For more information on hospice care, click here : www.hospicenet.org or www.hospicefoundation.org
Tell Us
Have you been through the process of hospice with a loved one? Would you like to see some kind of continued care by the former caregiver (doctor) instead of all communication ceasing? Would it make the dying process easier?
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I appreciate this posting as it touches home. The problem we have with the current healthcare model is that it does not incentivize practicing medicine with the heart. It is all about the bottom line: MONEY. There is no insurance out there that wants to pay for a physician's time when the patient is terminal whether he/she is under hospice care or palliative care (also known "end-of-life" care. Both options deny the physician the opportunity to influence "healing" for the patient and the love ones. It is not an aspect that it is emphasized in medical schools but also a direct effect of reimbursement practices. In our case, I was told to put my husband under Hospice Care. Why? Because three years ago he was told he only had 2-3 years to live. Today, his brain is fully functional, so I refused the offer from the start, not just because I did not like the "sound" of options, but because I know the psychological impact it would have had on my husband if he knew the healthcare system was already writing him off. So, he is still around us, paralized from the neck down, on a feeding tube, trache and night time ventilation. But he is at home, with his love ones and still actively participating in family life. Does his doctor call? Nope! The nurse does...Doctors do not do well when it comes to dealing with death and dying of patients, there is an implied sense of failure and most physicians do not like to fail, so they avoid it.
In contrast, Traditional Chinese Medicine (TMC) doctors embrace a different philosophy and the disease process is one of acceptance and preparation when all fails. Our medical model in the West has a lot to learn. Simple things like LOVE, COMPASSION, EMPATHY, HUMILITY coming from a doctor could help the patient and family heal. By the way, these traits along with Self-Care were discussed at a recent medical meeting I attended where most attendees were physicians. The message was clear, our current model is a disease-focused model not a patient centric one. We need to change the way we care for people. We need to go back to "healing" not just trying to cure disease.
March 11, 2009 - 9:31pmThis Comment
I do feel that it's essential for the former doctor to remain a current doctor, even in the case of having hospice take over. There's something horrible about being basically written off by your doctor that I think contributes to the loss of hope that hits so many people who are terminally ill.
March 11, 2009 - 5:03pmThis Comment