Doctors, Hospice, and Plato’s 2,000-Year-Old Comment

A son’s Dad had died about six weeks ago.

I phoned to check on the son and his family. During the brief chat, I learned that his father hailed from Wyoming, had been a wonderful grandfather to his many grandchildren, and how the family was dreading all of the future birthdays and holidays without “Gramps.”

In some of the bereavement calls I make for hospice, no one is home (or no one answers) and I’ll leave a message. Or the call is quick and perfunctory. On occasions, callers talk for quite a while because they’re hurting or lonely. I try to be ready for anything.

In this call, the man whose father had recently died, and who’d been served by hospice for only a handful of days, asked, “Why didn’t Dad’s doctor ever tell us about hospice?” He paused, then shared more of his father’s story. After multiple emergency room trips, procedures attempted and procedures considered, a surgeon had lingered in the father’s hospital room. It was this doctor— unknown to the family hours before—that finally explained the option of hospice.

Throughout my ministry, even before any official work with hospice, I’ve heard variations of . . . Why didn’t my doctor say anything about hospice? After all, hospice can be easily explained. Here’s a quote from my hospice’s website:

Hospice is not a place you go to die.  Hospice is a philosophy of care that focuses on patient comfort and quality of life rather than curing the person’s disease.  Hospice is a choice for someone with a terminal illness and life expectancy of six months or less, based on the normal progression of the illness.

If you followed the link to this page, you’d find more (and equally simple) details about hospice. If you only read that one web page, you won’t instantly become a hospice medical maven, but you’ll understand a number of essential whys and hows and whats. The hospice where I work isn’t unique; other hospices will post similar statements. For another easy-access resource, the “frequently asked questions” (FAQ) page at the National Hospice and Palliative Care Organization is here.

But why didn’t his Dad’s primary physician explain anything? Let me toss out a few possibilities.

  • Doctors are trained to battle for life. Death represents the enemy. Death is defeat. Therefore doctors—as with non-doctors—ignore hospice’s “comfort care” in order to “cure” a patient with another round of medications or procedures.
  • The health field emphasizes experts. Doctors are specialists on bones or brains or bile ducts or other B and beyond concerns. For example, a cardiologist convinced that a pacemaker is necessary right now for the heart may downplay or even ignore that device’s impact on the quality of life for an 80-something male with a terminal cancer.
  • Everybody likes to pass the buck. (Let another medical colleague deliver the bad news.)
  • If you mention death, death will come. (Do you think wearing a white lab coat and holding a stethoscope eliminates culturally-influenced superstitions?)
  • Whenever death is discussed, patients become depressed. (Who likes to make others feel sad, bad, or mad?)
  • Though often irritated by patients doing web research on diseases and post-surgery statistics (and who think they know more than their physicians), a doctor can rationalize that her or his patient will figure out things on their own by reading WebMD.

What scenarios have I forgotten? What would you suggest?

I always hope that doctors openly communicate with their patients, regardless of the subject. But a few—or more than a few—don’t. Maybe Plato underscored the grieving son’s question best over 2,000 years ago with: “The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the soul, although the two cannot be separated.”

Quality of life and the quantity of days can be included in an honest chat with patients and families.

Shifting from seeking any cure to providing comfort care is not about losing. We are all mortal.

Especially when someone faces death, they deserve to be treated as a whole patient, as a whole and complete person.

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

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  1. Here’s what you left out: most doctors don’t understand what hospice actually does and aren’t comfortable discussing what the family will have to cover with regard to 24 hour care. I’ve made this my mission: promoting the wonderful services we offer and educating about what else needs to be done for kind, gentle and thorough care.

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