The last goodbye: Comforting your dying patient

Physicians shouldn't distance themselves from patients who are facing death, experts say. The farewell process can be meaningful for doctors and the dying.

By Damon Adams, AMNews staff. Sept. 10, 2007.

H er doctor entered the hospice room early in the morning to check on Beth, a patient dying of breast cancer.

He checked her morphine pump and looked at her chart. When his beeper sounded, he said he had to go and would be back in a day or two.

That was the last time Beth and her family saw him.

It's a textbook example of how dying patients and family members can feel abandoned when their doctor leaves without a final goodbye. And it's one physicians who specialize in patient communication cited from Alan Shapiro's book, Vigil, when they wrote about saying goodbye to dying patients in an April 2005 issue of Annals of Internal Medicine. The authors concluded that saying farewell is a practice worth learning, for the sake of patient and physician.

Talking about death with a patient and dealing with the end is not easy, physicians say. Some say medical school taught them to keep a distance from patients, that getting too close was dangerous emotionally.

But the medical community recently has devoted more effort to examining and improving the last goodbye between physician and patient.

More schools have incorporated the issue into courses on communicating with patients and delivering bad news. Studies have examined the emotional impact of patient deaths on doctors and how physicians can reduce stress and depression in family members of dying patients. Increasing interest in palliative care and the hospice movement have led to greater attention to end-of-life care, too.