Wow, despite the recent exponential explosion in the amount of information and data about palliative care coming out, there are still some corners of the earth the news hasn’t reached. Those corners exist in my hospital! The other day I was on the floor finishing up a Palliative Care consult and an older cardiologist, who has worked with me in the past, in regards to one of his patients at End-of-Life-Care, sat at the table across from me. I was standing up to leave and he said something to me that caused me to become speechless for several moments. He looked at me and stated, “when I see you, I think that someone (a physician) has failed.” Of course I was awe struck and I don’t entirely remember exactly what I said. I said something to the effect of “that’s what’s wrong with us (as physicians) that we see death as a failure instead of part of the ‘life’ process.” Of course, you always think of better things to say after the fact and what I now wish I said was, “then you and I fail 100% of the time because ALL of our patients die at some point in their lives.” This is what the majority of us in the field have to deal with. Those that believe that Palliative Care is only End-of-Life-Care and only to be called in when a physician has failed. No wonder the physicians see us as the “death squad.” We are the firing squad to be called in when someone has been sentenced by their disease and called in to put an end to their misery. It has been a huge challenge to educate physicians to think of Palliative Care as an appropriate and helpful service that can be of benefit at the time of diagnosis, and extending through the active stages of treatment, rather than only at the End-of-Life. For those of us in the field, there is much work to be done! Carry on and Godspeed!
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Hospice Physician's Blog 
Yes, we have a lot of teaching to do. Good to hear your voice again. Keep writing.
Internal response to this type of statement:
“You give yourself too much credit, my friend.”
The greater failure is waiting too long for the palliative/hospice consult.
I agree with your comments. The use of a number of the terms associated with death seem to fall out of physician and hospital or clinical workers whenever I walk down the hall (Grim reaper, Doctor Death ect). I too am at a loss for words at times and I am taken aback by the comments. You would think I would be able to handle this better as time goes on. I find myself almost embarrassed to be there and less of a physician then the uninformed physian making the comments. I have grown professionally and personally over the years to understand my feelings surrounding death. I am however concerned that some of physicians I resected the most comment in the way you stated. Education is great however personal awareness of the information you already know is necessary also.
Thanks for the comments!
I have a physician that says, “how many patients have you killed today?” Really, it’s not that funny!
Your comments are right on the mark. A few months ago, my partner was asked by one of our cardiologists to see his long time patient, a man with a new head and neck cancer. We saw the man in the cardiologist’s office as a courtesy visit. The referreing cardiologist remarked that he really appreciated that we could help him and his patinet ut because, of course, as a cardiologist, his patient’s never died. W wre and remain dumbstruck. Naturally, the statistics regarding leading cuses of death in this country did not seem to penetrate the consciousness of the cardiologist. We have a ways to go.
Sometimes death is a failure, and we all know that. I hope your cardiologist doesn’t represent the majority of doctors at your hospital. When the palliative team were I belong, comes around, physicians, nurses and parients who know us smile. They know for (almost) sure that someone will get relief from pain, nausea, sleep disturbance, and symptoms like that. On top of that we are a merry threesome (small hospital). Physicians who know and respect what we do, know that in some way, we make a positive difference both for the patient and his/her relatives In a way they know THEY are not able to do to.What your cardiologist might have ment (underneath it all), is that I envy you the way you can deal with these patients who have little hope left for rescue, because the only way i am able to deal with these patients, is to abandon them! So I wish YOU a Merry Christmas and a Happy New Year, and your cardiologist a speedy recovery (though I doubt it)!
Thank-you for your kind words. My PC program is in a community hospital with physicians who have been there for many years. It has been a greater challenge than I ever expected. It would be nice to have other PC docs there, but alas I am alone. I hope that some day our team will be recognized as your team is in your hospital. I also wish you a Merry Christmas and Happy New Year.
Surprised? I thought this was the prevailing attitude amongst most physicians at most hospitals.
Where I work physicians often say tongue in cheek “here comes death and here comes dying” when they see us. What bugs me is when docs (and ancillary staff: speech, nutrition, occupational therapy, etc) feel compelled to sign off once palliative care is in the picture, when the patient can actually stand to benefit from continued visits. Alot of nurses misunderstand what palliative care is too, thinking that all we do is pain management
There is a physician in my hospital that keeps saying, jokingly of course (although I’m not laughing on the inside), “stop killing my patients.” Luckily we have more support from most of the ancillary staff. We’ve tried hard to educate all staff since for some reason physicians don’t get it.
We should not take offense at the jokes and ribbing. These doctors are using humor and denial to protect themselves. If we are to consider ourselves to be compassionate, then we must extend this compassion to our colleagues with the understanding that they are only defending themselves against the big something that nobody living really understands. As Neil Young says, “Don’t let it bring you down.”
How old is the physician? Or does such presumptiveness span all ages:
lol, probably in his 60’s
Humph, I thought the corners of my hospital were the last untouched areas! I try to tell people “I’m not Doctor Death, I’m Doctor Feelgood” when I’m there for symptom management, especially. I have had nurses try to block my consults because “You don’t need to see them; they’re not dying.” So I go into my prepared answer , which is usually something like: I am here to support this patient and family during this difficult time in all the realms of suffering they experience whether or not they are dying. *sigh* Sorry I am so late to respond on this one, but it’s hitting home today. Stay strong.
Thank-you, I will stay strong. Today I had one of those days that made me feel like I went into the right profession and that I’m doing some good in the universe. We have a lot of work to do. By the way, We should all have “I am here to support this patient and family during this difficult time in all the realms of suffering they experience whether or not they are dying” tatooed on our forheads so that we don’t have to repeat the same or similar phrases to the staff 🙂
For all the physicians like that older cardiologist who come right out and say that death = failure, I suspect there are many more who harbor this belief subconsciously.
“A Meeting with Failure” is a short article from Oncology Times that illustrates the problem and a solution: http://tinyurl.com/ylhuluh
With hope, Wendy
Thank you for recounting that experience. It will take a generation or two to bring about a cultural change.
I do not know what area of the states you are in but I wish we had some of you in East Texas. We are in dire need of physicians willing to open their minds to the value of hospice and end-of-life care. Not at the very end of life but at the diagnosis stage of the disease instead of the final hours or days. The patient and family cannot fully benefit from all that hospice has to offer when there is such a short time to offer it. I market for a not-for-profit hospice and get frustrated on a regular basis at the level of ignorance and lack of interest from physicians who say “I do not have anyone who qualifies for hospice”, yet these same physcians have patients who are frequent fliers to not only their office but the ER as well. I have even had a physican say “My patients don’t die”. Oh really?
I would appreciate any insight….
Thank you for your mission in providing hospice care. It continues to be a challenging, frustrating and rewarding field all rolled together. All of us in the field know how beneficial hospice is and when referred in a timely manner, the patient and FAMILY benefit from the comprehensive care hospice provides. One of the main barriers definitely are the referring physicians. They don’t want to lose their patient to hospice since most don’t feel comfortable managing them on hospice. There are also financial, emotional and misinformed reasons why physicians continue to be the barrier but those in our field and as I mentioned in another post, Transitional Care and Palliative Care (also known as supportive care by some facilities) will hopefully engage patients more upstream and help refer patients earlier in final stages of the disease rather than days to weeks before death. Keep up the good work and I appreciate your patience.