Sunday, May 22, 2005

The Power of Goodbye

Seattle Times, May 19th, 2005

One cancer patient calls them "MIA doctors" — doctors who go missing in action when their patients are about to die.

Doctors, even with patients they've known for years, often avoid saying goodbye, says Dr. Anthony Back, a cancer specialist who teaches young doctors communication skills. And their inability to say those little words often leaves patients feeling perplexed and abandoned at an especially vulnerable time.

Back, who wrote about the problem in last month's issue of the Annals of Internal Medicine, said he was stunned when he asked his students, all cancer specialists in their last stages of training, if they acknowledge to patients about to die that they won't be seeing them again.

-the rest of the story-
Posted by HypnoKitten at 3:26 PM
4 Comments:

Blogger Third Degree Nurse, at 5:54 PM  

This really hit home with me. My husband's oncologist totally avoided any discussion of prognosis with us except the casual "anybody going through cancer should be sure they have their affairs in order speech."

Toward the end, I finally caught him on his car phone, no less, and asked him point blank, how much time he thought my husband had. He said "about 2 weeks." A very accurate assessment which I appreciated because I had very little grasp of the process of dying. I understand the awkwardness, emotionalism, and not wanting to "give up" on a patients. But avoiding the issue gives mixed signals to the patient's family, none which flatter the oncologist.

Blogger Sassy, at 11:45 AM  

Hey! What a terrific blog!! I love this!! I'm gonna go to work now and come home after my shift and read some more. Thanks for adding me to your blog links.

Blogger may, at 3:54 PM  

i'm just curious, would it be the same for nurses if we have that option to go MIA when the patient is dying? or are we there with the patient because we are supposed to and can't literally leave?

Blogger HypnoKitten, at 5:42 PM  

I'd have to look for the article, but I saw something the other day that said that as nurses were becoming more able to do doctor-type things, doctors are being given more classes in patient teaching, cultural compassion, etc. Think of all the places nurses can go and things they can do that weren't available 20 years ago.

And specifically, about nurses going MIA - I don't think most of us have that same long-term patient relationship that an oncologist would have with a patient. Some of these docs have the same patient for years and years. When the end of life comes, it may be easier for them to avoid it. Why? Fear of facing the patient and knowing that you couldn't do anything more, maybe an unwillingness to show emotion, professional pride, I don't know. As nurses we don't often have that sort of relationship with the patients, and we're acting more on a here-and-now basis (of course, I'm generalizing and yes, there are exceptions).

I guess what I'm trying to say is that if someone is dying around me, I may have met them only a few days ago, so I have no reason to feel the need to avoid the subject of death, and am in fact trained to be able to help people cope with the transition. An oncology doc's purpose is to try and keep people alive, therefore they may not feel they have a purpose at the death.

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