Thursday, March 12, 2009

Doctor and Patient - When Patients Feel Abandoned by Doctors - NYTimes.com

During my surgical training, I was taught never to abandon a patient, no matter how difficult the operation or how complex the clinical course. As one senior surgeon put it, "Once you lay your hands on a patient, that patient is yours."

At the time, I embraced the idea of sticking with my patients and believed it was the fundamental value of my chosen field. Since then, however, I have learned two things. First, that every physician, no matter his or her specialty, is taught the same thing. And second, that despite our long-held belief that doctors should never abandon their patients, many of us have already done so.

This week, The Archives of Internal Medicine published the results of a study from Seattle that examined feelings of abandonment at the end of life from the perspective of patients, caregivers, nurses and physicians. Investigators from the University of Washington and the Fred Hutchinson Cancer Research Center followed 55 patients with terminal diseases in the year leading up to their death, as well as the dozens of family caregivers, nurses and physicians involved in their care.

Most striking, and perhaps most poignant, were the discrepancies the investigators found between doctors and patients. While the doctors were aware that dying patients might feel abandoned and even took what they believed were steps to prevent it, patients and their caregivers continued to feel abandoned by their doctors both in the period leading up to and at the time of death.

One reason, according to study investigators, was that physicians were unaware of the importance for patients, and caregivers, of closure. A sense of closure helped mitigate any feelings of abandonment, they found. And efforts to achieve closure could range from openly acknowledging that a visit might be the last with the patient, to calling the family or sending a condolence note after death.

More ...

http://www.nytimes.com/2009/03/12/health/12chen.html?pagewanted=all