Sunday, April 12, 2009


Here's another interesting -- well, disturbingly interesting -- study from the Archives of Internal Medicine. Researchers were talking with patients about hope and their views of the future, but the patients kept bringing up their fear of being abandoned by their doctors. They worried about the loss of their physician's medical knowledge and about the loss of the physician-patient relationship. Family members said the same thing. One offered this quote: "...they're [that is, the hospice team] just here to make you comfortable until you die. But you can't seek your regular treatment from your doctor. Your doctor is out of it."

Physicians, too, worried about feelings of abandonment that their patients might experience. They seemed to understand that continuing treatment, for patients and families, signaled a willingness to keep the relationship going; presumably, a decision not to press on with therapy was a sign, to patients, that their doctor was giving up on them. As a hospice and palliative medicine doctor, I've often wondered why my fellow physicians so often continue treatment even though they know -- and I know they know, because I've asked them -- it has a slim to none chance of helping. Maybe it's not about the treatment. Maybe it's about the relationship.

I'm so troubled by these findings. My hospice team works hard to keep the patient's doctor involved. But many physicians tell the nurses not to bother them, and they expect the hospice team to take over the case once the patient is referred. Others are furious if they're not kept up to date on everything. From the physician side, at least, it seems that the abandonment issue works itself out in many different ways.

Keeping silent when we ought to be explicit...this is a real problem with patients getting honest, direct information, and it has an effect on the question of abandonment, too. Just when they need most to know that they're not alone, patients and families perceive that they are losing care and caring. Can't we just talk?

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