doctors abandoning dying patients

[freelancewriter]

Very interesting article in the NYT:

"A Doctor's Duty, When Death Is Inevitable"
http://www.nytimes.com/2004/08/10/health/10brod.html

This article quotes a letter to an oncologist from a widow who feels the oncologist abandoned his wife at the end of her life.

The letter is more powerful reading than most articles I've read on the subject. Here's a quote:

"...at the end, to her (and my) profound disappointment, you failed her. When you realized that you could do no more to reverse her progressive disease and that death had become inevitable, you abandoned her.... The empathy you had displayed was replaced by what she experienced as indifference."

It must be difficult for a physician to be in such a position. If all treatments have failed, the physician him/herself might feel like a failure. Pulling away seems like a natural coping mechanism.

Palliative medicine is a relatively new field. Hopefully, over time, the transition from treatment to hospice can be smoothed. If I were in the same situation, I would want my oncologist to remain with me to the end, but the structure of medical environments may not allow for this. I don't know.

Any thoughts?

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[MustafaMond]

This is why good Onc-nurses, a good home hospice program, and good communication are key to the care of the dying patient.

 

[beyond all hope]

We deal with this sort of thing every day. Lots of people are dying from various diseases, and in only a fraction of the cases do we have a cure. Cancer is one of the more glamorous diseases, but emphysema, heart failure, liver failure and kidney failure are just some of the diseases which can become end-stage and there's little more to do than supportive care (unless they qualify for a transplant, of course)

The key is good communication with the patient, like the previous poster said, and humility to realize that many situations are beyond our control.

Pulling away is a coping mechanism but its not necessary if you realize that you're not only there to cure but also to comfort.

 

[neglect]

Terrific article.

Agree with previous poster. Spend any time in hospice and you'll see all the end stage CAs, but also every other disease: end stage COPD, cirrhosis, ESRD, CHF, Strokes, dementia. Most diseases we deal with (OK, not talking to ophtho here), end.

We'll never know what happened between that doctor and his patient. One thing not mentioned in the article is the incresing compartmentalization of medicine. The oncologist's job is to treat the cancer - the underlying problem. Once his services are no longer needed, one can imagine his thoughts: I'm not needed profesionally, the hospice people know what they're doing and they aren't calling me, I have to see 30 follow ups today, and (real world thought) I'm not going to get paid for this.

His failing, if there was one, seemed to be not recognizing that these people wanted a doctor/human connection. I think that gets to the core of it. But on the other hand, I'm not so sure about the place of human connections in modern medicine. It's sad to say. Example: how many of us give our personal numbers to patients? Do we have them over to dinner? Patients are patients, not friends. How much we establish them as our friends is an individual decision.

Thanks for the article.

 

[DD214_DOC]

That woman would have been better served by being visisted by a man of the cloth. Whether you buy religion or not, those that do, I would think, would be more comforted by spending time with family or a minister, rather than a doctor who can't do anything.

Physicians aren't exactly trained to counsel the dying as well as ministers.