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We need to get back to seeing our patients during their final days.

Fam Pract Manag. 2023;30(3):31

Author disclosure: no relevant financial relationships. No real patient names have been used.

end of life

As family physicians, we devote our careers to taking care of patients “from cradle to grave,” during some of their happiest and most difficult times. Over the years, they invite us into their lives, and we bond with their families. In turn, they ask about our kids and admire any new pictures or drawings we post on our exam room walls. Yet, during their final days, arguably the most important ones, we are frequently absent.


I had taken care of Jack for more than a decade. He was one of my favorites. When he turned 80, I told him that he was still one of the coolest guys I knew. Our conversations were frequently about his love for the beach and his support of local theater. Our clinic visits were both medical and social in nature. I also took care of his wife before she passed away from metastatic melanoma. His daughter and granddaughter remain my patients to this day.

Jack was diagnosed with primary biliary cirrhosis decades ago. But like many patients, his daily ursodiol kept the disease under control — that is, until his liver could not handle all of the years of subacute damage, which finally led to liver failure. He began to experience encephalopathy and confusion. He had problems with balance and frequent falls. There was some discussion of vascular dementia. During one visit, I could tell that Jack was not able to recall my name. He had always called me Adam.

His daughter managed his care as best as one could. We had all of the appropriate conversations as Jack got sicker, from power of attorney to hospice care. I saw Jack every few months during his final years.

A couple months after our last visit, I suddenly received a notification from our local hospice group. Jack had passed away. My jaw dropped. Before I picked up the phone to call his daughter to express my condolences, I noticed that the date of his passing had actually been two weeks prior. Why hadn't hospice notified me earlier? I spoke to his daughter, who understandably thought I had been made aware. I felt terrible that I couldn't reach out to his family sooner. I never got to say goodbye.

The circumstances were a little different with Jane. She was a wonderful 90-year-old woman who had been a cheerleader in college and carried that energy into her later years. Her daughter and two granddaughters took care of her beautifully at home. Being Jane's doctor made me feel like a family physician from decades past. She and her family had my cell phone number for any emergencies, but they used that access judiciously.

Over the years, Jane's body started to slow down. She exhibited more confusion. She dealt with some recurrent infections that landed her in the hospital. With the onset of atrial fibrillation, her heart started to give out. The week before her passing, Jane fell and broke her arm. Due to her weakness and cardiac condition, she was admitted to the hospital. On her last day, her daughter called and told me that she probably only had hours to live. I intended to go see her during my lunch hour before I started seeing my afternoon patients. But my last patient of the morning required more time and attention than I had anticipated, so I couldn't go to the hospital until the end of the day. I received another call shortly after lunch. Jane had passed away. Her granddaughter was holding her hand at her bedside, telling her it was OK to let go. She gave one last breath and fell asleep. Again, I never got to say goodbye.

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