EastCoastLadi Posted May 13, 2006 Share Posted May 13, 2006 In my never-ending search for information, I happened upon this article from a couple of years back....it just brings tears to my eyes Grace (Jane Brody, NY Times)---The letter that appears below was written by the husband of a woman whose oncologist had cared for her for nearly seven years, and then abandoned her in the final weeks of her life. A copy of the letter was sent to Dr. Diane Meier, director of palliative care at Mount Sinai Medical Center. Dr. Meier told me, "I have seen this happen hundreds of times, causing profound hurt and injury to the patient and family that compounds the losses a thousandfold. Patients wonder what they did to offend their doctor, why they are no longer worthy of attention. And, of course, patients do not realize that since they 'failed' therapy, the doctors feel they 'failed' the patient. When patients are so sick, the doctor-patient relationship is deeply personal and vulnerable and unequal. Doctors need to know the cost of this behavior for their patients, whose interests they are sworn to put first." So, like Dr. Meier and the bereaved husband who wrote this eloquent letter, I am hoping that physicians whose patients no longer respond to active therapy will read this column. The husband chose to bring his wife's experience to public attention in the hope that other dying patients will be spared similar anguish. I have deleted the doctor's name, the name of the patient, and the hospital where she was treated, because the point is to highlight not the specifics of this case, but the broader point about a behavior that, as Dr. Meier points out, is all too common. The doctor works at a major New York cancer center. ====================================== Dear Doctor: I'm writing to you in reference to my wife, who died on May 29, 2004. I wish to make clear from the outset that I am not impugning your medical competence but am seeking to bring to your attention what, in my opinion, constitutes a grave breach of the moral contract you entered into with her. As you know, my wife was diagnosed with lung cancer in 1997 and was treated successfully by you for almost seven years. During that time, she developed a relationship of confidence with you which, given her many unhappy past experiences with doctors, was both encouraging and surprising. And yet, 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. You evaded her telephone calls; you waited 10 days before informing her of the April 2004 CAT scan results; you pulled away. The empathy you had displayed was replaced by what she experienced as indifference. And, sadly, your behavior dovetailed perfectly with the New York Times article "Facing Up to the Inevitable, in Search of a Good Death" of Dec. 30, 2003, which speaks of physicians who withdraw from patients rather than address feeling 'guilty, insecure, frustrated and inadequate.' It is true that you informed my wife, offhandedly, that the hospice staff would care for her during the final phase. As they did - with dedication and great dignity. However, your coldness during her final weeks made it more difficult for us because she felt that she had lost the medical anchor you had provided and no longer had a doctor she could trust to explain what was happening to her as her body withered and her vulnerability grew. Much precious time was wasted trying to turn her mind from your dismissal of her that she experienced as a professional and personal betrayal. Which I believe it was. Would it have cost you so much, doctor, to have picked up the telephone to speak with her after almost seven years of treatment? Would it have been so intolerable to you to have looked into her eyes - at the hospice perhaps - and told her that you wished her well and wanted a chance to say goodbye? Were you truly unable to offer even a shred of comfort, a word of condolence to her family? Had she really become no more than another statistic, a failure you preferred to brush aside? I am asking you to help ensure that oncologists like yourself, who work with many patients they are bound to lose, not abandon them emotionally, as you did. I am asking that you suggest that your hospital consider setting up a training program for doctors like yourself so that other patients can be spared the pain of the rejection my wife experienced. Because it is my conviction that doctors treating terminally ill patients have a moral obligation to stand with them from start to finish even when, at the end, those patients must be transferred to hospice care. It is not easy for me to tell you that from this perspective, I believe that your failure was monumental. Perhaps this letter will help you display greater feeling with future patients and not ask them, as you did my wife from a distant height, 'What would you like us to do for you?' What she wanted you to do was simple: she wanted you to speak to her with courage; she wanted you to show a bit of concern, which would have meant as much to her then as all the chemotherapy you prescribed when there was still hope; she wanted you to help her die more peacefully - as you had promised that you would but did not. It would have made the work of the hospice staff easier. It would have been a consolation to her and to the family and friends who loved her. =========================================== Dr. Dan Shapiro, a clinical psychologist at the University of Arizona, is one of a growing number of experts who teach medical students and physicians the importance of healing patients even when they cannot cure them. He pointed out that "when patients are referred to hospice care, some doctors think that it's their cue to bow out." At that point, he suggests that patients make it clear to their physicians that they want them to stay involved. Dr. Shapiro advises patients to tell their doctors: "I don't expect miracles from you. I appreciate everything you've done up to now. I and my family would be grateful, even though I may be dying, for your continued help with my quality of life and dignity." Patients might then add a specific request, he said, like asking for help on how to remain clear-headed while still getting appropriate pain relief. Such a statement expresses gratitude and takes the physician off the hook by saying that the patient does not expect miracles but would like help in achieving a peaceful end, Dr. Shapiro said. "This makes the physician feel useful and less likely to retreat." Quote Link to comment Share on other sites More sharing options...
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