Hospice for Doctors

It is hard to lie to patients who are dying.  To look a fellow human in the eye and tell them “everything will be OK,” is painful.  To give treatment that is unlikely to work is emotionally exhausting.  To watch someone die having never been honest causes burnout.

Denying the obvious spread of disease conflicts with what the patient perceives, and what the doctor knows. Even though the goal is to soften difficult news, the result of deception is isolation, confusion and suffering. This exacts a terrible toll on the doctor.  However, for many physicians it is not clear what to say or what to offer when therapy fails.  What has a physician to offer but false hope?

The only real choice for a physician is to tell the truth.    Physicians owe their patients complete information, and compassionate prognosis. The communication of realistic goals in terminal disease, takes patience, experience and compassion. Gently confirming that the disease is increasing and defining what is truly possible is to allow real comfort.  Setting achievable goals of life quality is a gift to the patient and family. Nonetheless, for doctors trained in diagnosis and cure, it may not be obvious how to transition to compassion and comfort.

In treating patients at the end of their lives, the physician benefits from palliative medicine.   Instead of the frustration of giving useless treatment and contrary advise, there is the satisfaction of a patient who feels better.  Instead of medicine that may not work, there is therapy to improve quality.  Instead of pulling patients away from their families, the doctor can help each patient share this important part of life.

The physician never has to desert his patient, but can maintain that vital relationship throughout each life.  Through honestly communicating and using the techniques of palliative care, a physician has the satisfaction of really helping.  In addition, the doctor knows that patients receiving quality “end-of-life” care, actually may live longer.

Hospice is good medicine for doctors.   They do not need to give the false “hope” of life forever.  The physician can always give true “Hope” that their patients will live with dignity and they will walk the path together.



  • lyn hobart
    How true are these words. This is a very important part of a patients life and they need all the support from their carepartners possible. We owe it to them.
    • James Salwitz, MD
      I guess that is really the key...hospice and palliative medicine gives doctors the path and the tools to give the care which their patients so desperately need. Thanks, jcs
  • Jo
    That is very good. I wrote on here before under Cancer 101. My husband has had a slow-growing glioma for 25 years. The last MRI showed slight growth. The oncologist met with the tumor board. He then called me to tell me it had grown a little and he has a feeling if my husbsnd has another scan in 6 months, it will have grown about 1/4 inch more. He said the tumor will eventually affect all my husband's faculties and his brain stem and eventually kill him. It is in the ventricle and left temporal lobe. It had "seeded". I was hesitant, then the oncologist said he could put him on hospice and that was a perfectly good decision too. I did feel relief about that, but also kind of bad because that meant no treatment. We ended up going back to the neurosurgeon and talking with him. He said surgery would not make my husband better but it will tell them exactly what the growth is and the stage it is. He even thinks it may have become Stage 4, which I seriously don't think because I think it would be growing a lot faster now! Anyway, now the surgery is scheduled for Jan. to biopsy and resect it. I have been pulling away some from my husband since then because I am afraid he is going to have seizures again after the surgery or maybe other deficits. He all ready has word-finding difficulty. I am second-guessing, thinking we should have chosen hospice. My husband says I should think positive, but I seem to think of all the things that can go wrong with surgery. He has all ready been through a lot and me too. I know you cannot give advice over email and I don't expect that. I think there is a lot to be said for hospice, but either way, it is a hard decision. My husband is really doing pretty well considering and I don't want to lose more of him or his brain..which containsbhis essence. It makes me very sad.

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