14 DAY TRIAL // The issue of medical health care in the case of terminally-ill patients has been under debate for quite some time now, but to little practical use. Doctors say that they do all they can for the patients with no survival chances, and that they try to divide their time as best as possible between these people and all the others they see, with lesser medical conditions. On the other hand, patients who are about to die say that they feel neglected by their physicians, and that they would have expected a different level of health care in their last days.
According to a Seattle Cancer Care Alliance oncologist who has published a new study in the latest issue of the journal Archives of Internal Medicine, patients and their families experience two kinds of problems with doctors in such situations. First of all, before the sick person dies, he or she feels a sense of discontinuity, as far as their personal relations with the physicians go. After the death, the family is left without a sense of closure, as no discussions take place between them and the care givers.
“Doctors often don't realize how important this issue is for patients and their families. Something as simple as a phone call can go a long way toward allaying abandonment concerns,” patient/physician communication expert Anthony Back, MD, who is also the lead author of the newly-published study, explains. He also adds that physicians lack a sense of closure just as much as the families do, but that they do not necessarily associate this type of feelings with abandonment.
“At first glance, continuity and closure may seem mutually exclusive, but these elements reflect different needs occurring at different times in the dying process. Early on, patients and family caregivers fear that their physicians, whose expertise and caring they have come to depend on, will become unavailable,” the author writes. “Most physicians are not consciously aware of having abandoned their patients. Instead, they report a lack of closure or a feeling of unfinished business.”
Back recommends that medics make time to visit their terminally-ill patients as many times as possible before their death, and that, afterwards, they get in touch with the family, in order for them to give both its members and themselves a sense of closure. The last visit should also be anticipated, so that at least the patient gets a feeling that the doctors are near him or her in their final hours.