Pauline Chen, MD, a surgeon and health writer for the New York Times, published an article that addresses the fact that so often, toward the end of life, patients feel abandoned by their physicians.
I've heard this complaint before. It comes from patients (or family members of patients) who have a terminal disease or life-ending injuries, only months or weeks to live, and have either decided they no longer want to fight their disease, or no further treatment is available. They tell me their doctors won't return phone calls, won't make appointments to see them, won't visit them, even in hospice. In short, once they decide to stop fighting, the doctor considers them persona non grata.
Dr. Chen cites a study recently released in the Archives of Internal Medicine that tracked the last year of life for 55 patients, and the interaction among the patients, family members, their physicians and nurses. It clearly showed that patients felt abandoned. The families were seeking closure and did not feel as if they ever got there.
I've heard these arguments about why doctors would abandon their patients, even though they know -- they are taught -- that it's not acceptable either therapeutically for the patient, or professionally for themselves. One argument is that physicians work so hard to keep their patients alive, that when the patient prepares to die, the doctor sees it as a failure. The other argument is that the physician is affected emotionally and is afraid s/he won't be able to keep emotions in check.
OK. Maybe. or Maybe not. I'm sure those reasons are accurate for some abandoning doctors, at least in part.
I think there are other reasons, too -- related to time, priorities and of course, money.
A doctor with a busy billable patient load doesn't have time to visit patients in hospice or at home. And since those those patients have a shelf life -- they are no longer "customers" (although I'm not a fan of that word in healthcare, it certainly fits here.)
If those doctors don't provide services to the patient, then they can't bill anything either. Granted, some of them are phoning in prescriptions for that dying patient - pain relief drugs, for example. But that's the point. They can phone them in. Why spend the time and gas money to visit if they don't have to?
Further, in a healthcare system that places a value on a very short, finite amount of time per patient, talking to a dying patient would certainly eat up too much time. Especially since there would be no improvement in the patient's health. Surely a dying patient is interested in chatting about... what? Dying?
Dr. Chen interviewed Dr. Anthony Back, a specialist in doctor-patient communications, who has written about this tendency toward abandonment. He suggests patients who know they face the end of their lives should be direct with their doctors and ask if they may phone them on occasion. Then he conceded that patients who believe they have a good relationship with their doctors often don't think to ask because they don't think it will ever be an issue.
Have you felt abandoned by a doctor? Perhaps your loved one was dying or maybe you've experienced it yourself? Please share your experience in the patient empowerment forum.
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