Here I sit at the end of hospice IDT (interdisciplinary team) meeting with a sense of sadness. I feel compelled to write this entry. We have just reviewed and had a quiet moment for all the patients who have died in the last week. The list is long as usual but what saddens me the most is there are names on this list that I’ve never heard before. To be the Medical Director of a hospice and to not recognize a name is a tragedy. If this only happened once in a while it wouldn’t be so sad but it happens every week without fail. Why does this happen? It happens because so many patients and families don’t know about the benefits of hospice care. They don’t realize that hospice is about LIVING not dying. It’s about living the rest of your life on your terms, living your life with as much quality as possible, it’s about allowing your family to participate in a part of your life that will unfold no matter what we do. If you couple the above with physicians avoiding conversations related to End-of-Life Care, you get patients referred to hospice in the last hours and days of their life. I look at these names and feel regret for the patients and families as I think how much help our hospice team could have been physically, spiritually, psychologically and socially if we’d been involved during the last six months of their life. Next week I’ll have to start my apologies all over again to a list of names I’ve never seen before. “Sorry, I don’t recognize your name” I’ll be muttering under my breath as I go down the list and read the names one by one.
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Constantly educating on Hospice, even today there is still many misconceptions of our work.
Oh hugs,. hugs. I am a fundraiser for a hospice in England. So sometimes I get to know patients as they enter the Hospice and then I see their names as the donations ‘in memory’ come in and I think ‘Oh, I recognise that name’. It’s the opposite for me I guess.
Dear Hospice Physician,
I write on ScienceBlogs and just posted an piece on misunderstandings about hospice care. I link to your Nov 1 blog post and include an excerpt from it. My post is at:
http://scienceblogs.com/thepumphandle/2011/11/my_sister_is_not_deaths_grim_r.php
Hello,
I wanted to drop you a line and compliment you on your website and blog. Nice layout, good tips, and an overall great resource on senior health and quality of life.
I currently work for a skilled nursing and rehabilitation facility and we are interested in advertising on your site because we think it would be a great fit for us.
Please let me know if this is possible.
Thank you for your time. I look forward to hearing from you.
Hello,
I have shared the same feelings you expressed above. Sadness for those patients who we never got to really “know”, but also frustration when their referring docs/attending of record (who may have known their patients for years) decide that they no longer want to participate in their patients medical care once they enroll in hospice. If I was that patient, I would feel abandoned.
I am both a geriatrician and a hospice and palliative medicine doc. I work at an academic medical center and in my geriatrics role we literally follow our patients wherever they are: clinic, home, nursing home, hospital, hospice.. to provide medical care. I’m also the medical director for a local hospice agency.
I’ve always believed that the patient centered multidisciplinary approach to care is the best way to go. The nurses at the hospice agency I work with tell me that they’re having trouble getting community docs to call them back when they need to reach them to let them know of changes in their patient status but also to let them know that we would like to adjust the patient’s medicines but would like to include them in the decision making process. I’ve even had PCP’s refuse to sign their patient’s death certificates (even when the pt was only enrolled in hospice for less than 5 days).
So…I’m curious, do you have some tried and true tips on how to get community docs to work in a collaborative manner with the hospice agency you work with?
Thanks
Rachel
Rachel,
Thank you for the comment and continued success in your practice. We seem to be similar in our practice and passion for hospice and palliative care. In regard to the issue with other physicians, I agree this can be a challenge. When I first started hospice, I noticed after many an angry phone call (doctors who wanted to be involved and didn’t get calls and those who didn’t want to be involved and got phone calls and everyone in between) there are three groups of physicians. 1. The physician who has known the patient for several to many years and wants to be actively involved with the care plan including all the phone calls. 2. The physician who may or may not have known the patient for many years and wants to be updated periodically with what is happening with his patient but doesn’t want to manage or get phone calls. 3. Lastly the physician who wants to turn the case completely over to the hospice physician. This is usually the case, for example, if the patient didn’t have a primary care physician, was admitted to the hospital by the on-call panel physician (who didn’t know the patient prior to admission) and was subsequently discharged on hospice care. There are exceptions to the above, for example, I know a physician who does a very good job of presenting hospice to the families and because he has the utmost trust and confidence in the team the families are ok with the “hand-off” to hospice. I have found that by understanding the referring physicians preference from the beginning, it not only caters to the physician but also prevents angry phone calls, patients feeling abandoned and frustrated nurses. I made a form with 3 levels of involvement and when a patient is referred to hospice the physician checks off his/her level of preference including the method by which to best contact them (cell, work phone, email etc.). When I initially rolled it out, the administration was somewhat skeptical about the physician response, however, I had about a 90% return on the forms (sometimes with some nudging from our administrative assistant to their nurse). This drastically reduced most of the issues mentioned above and we had happier referring physicians. Let me know if you’d like a copy of the form and you can tailor it to your needs. You can shoot me an email at palliativecaremd@yahoo.com and I’ll respond from my personal email. Thank you again for your comments and your work.
Cordially,
Hospice Physician