A few comments on the care of the terminally ill

It is helpful to consider the physician(s), the patient, immediate family (spouse, children, and parents), and hospice when appropriate, as a team working together for the benefit of the patient. This does not trump the physician - patient relationship that remains inviolable.
A physician cannot and should not care for the patient without family involvement. Caring for the family is critical to the care of the patient.


WHOSE FEELINGS ARE BEING CONSIDERED?

For the physician - be certain you are acting on behalf of the patients feelings and well-being and not your own. Some physicians seem to have difficulty acknowledging the futility of treatment when that stage is reached. The physician must recognize when hope becomes detrimental and the patients best interest is better served by a reality check.

For the family - It is painful to learn that a loved one has been diagnosed with an incurable disease, and it is understandable why someone’s difficulty in letting go can result in advocating care choices that are not in the best interest of the patient.

COMMUNICATION

It is imperative that everyone be informed of conditions critical to care decisions. It was my practice to tell the patient and family clearly and accurately the diagnosis and possible implications and prognosis. I did this early, usually at the time of diagnosis. After that I spoke in more guarded terms, letting my feel for what the patient was able to accept be my guide. This is important to nurture hope. Later, when conditions become clearly irreversible, and unrealistic hope may become detrimental, it might be necessary for the physician to inject a more realistic appraisal to the patient and the family. This is when the art of medicine is called for.

*****

The physician’s role does not end when hospice is called in. and yes, there is still a place for a house call, even if it is just to say hello and hold a hand. Saying you are too busy is a feeble excuse.

My daughter Beth, who does not do in-hospital work, informs me that when her patients are in the hospital she calls them directly on their bedside phone to ask about them and let them know she is concerned about their well being. (Is it any wonder that I am so proud of her?)

More than anything else, I believe the role of the physician is to communicate to the patient and their family that dying is a natural phenomenon that every one of us will face, sometimes prematurely, and that it is in everyone's best interest when the imediate family plays and active role. The time a family spendds together during the final stages of dying is invaluable to everyone. I learned this from my mother.