It’s hard to let go of a patient. In the same way that families struggle to admit their loved one is dying, physicians often struggle with releasing a terminally ill patient into a palliative care or hospice provider.
Physicians are committed to saving lives by conquering disease. Having a frank discussion with a terminally ill patient about end-of-life care may feel like giving up hope, for everyone. But knowing when to have these discussions is an important part of family medicine. Guiding your patients through the process of advanced directives and establishing a health care proxy is an important part of a natural life process. Living includes dying but physicians often struggle to recognize that they cannot beat death — but only sustain life for as long as possible.
On the National Landscape
Hospice is a relatively new phenomena in the health care paradigm. The first hospice in the United States was created in 1974, although the concept of hospice dates back to medieval times. Today, hospice is generally recognized as the gold standard for end-of-life treatment, and more than 5,000 free-standing facilities provide this care around the country. The growth of this movement has coincided with increasing interest by consumers in controlling their healthcare options, despite debilitating illness that threatens their ability to make important end-of-life decisions.
Today, a number of national insurers have begun reimbursing providers for having end-of-life discussions with terminally ill patients. CMS appears to be planning on doing the same, although the debate has not concluded. The AMA has already come out publicly in favor of it. Since Medicare sets the groundwork for new policy that ripples across the healthcare spectrum, it is expected that more physicians will naturally elevate the discussion around end-of-life comfort care and advanced directives.
If you are a primary care provider and have made the difficult decision to transition your patient to hospice, your journey with that client is not necessarily over. Many physicians and mid level providers feel left out of the patients transfer to hospice. However, palliative care was invented to ease that transition for both the provider and patient. The palliative care team could include a physician, pharmacist, social worker, dietitian, and volunteers. Their goal is to alleviate suffering, improve the quality of care, and help families and loved ones cope with stress and the emotional burden of terminal illness. Together, this interdisciplinary team can work to help each individual understand and accept end-of-life treatment as a bridge to a new journey, while alleviating suffering and helping families cope.