Anthony L. Back, MD; Robert M. Arnold, MD; James A. Tulsky, MD; Walter F. Baile, MD; Kelly A. Fryer-Edwards, PhD
Acknowledgments: The authors acknowledge all of the fellows who have participated in Oncotalk retreats over the past 3 years, the amazing actors who have shown us the power of goodbyes, and Holly Prigerson, PhD, for helpful conversations about empirical studies examining grief.
Grant Support: By the National Cancer Institute (NCI R25 92055).
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Anthony L. Back, MD, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, Box 19023, Seattle WA 98109-1023; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Back: Seattle Cancer Care Alliance, 825 Eastlake Avenue East, Box 19023, Seattle, WA 98109-1023.
Dr. Arnold: University of Pittsburgh Medical Center Montefiore Hospital, 200 Lothrop Street, W933, Pittsburgh, PA 15213-2582.
Dr. Tulsky: Durham Veterans Affairs Medical Center and Duke University, 508 Fulton Street, Durham, NC 27705.
Dr. Baile: University of Texas M.D. Anderson Cancer Center, Unit 431, Box 301402, Houston, TX 77230-1402.
Ms. Fryer-Edwards: University of Washington, 1959 Pacific Avenue, Seattle, WA 98195.
Back AL, Arnold RM, Tulsky JA, Baile WF, Fryer-Edwards KA. On Saying Goodbye: Acknowledging the End of the Patient–Physician Relationship with Patients Who Are Near Death. Ann Intern Med. 2005;142:682-685. doi: 10.7326/0003-4819-142-8-200504190-00033
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Published: Ann Intern Med. 2005;142(8):682-685.
Ms. White is being discharged with home hospice after an admission for malignant bowel obstruction. Her physician, Dr. B., has come by on rounds and has finished answering her questions. He is finishing up his encounter: “Well, it sounds like everything is ready for you at home, and I'm glad you're feeling better. You'll be in good hands with hospice. I'll see you later.”
Ms. White, a woman with metastatic colon cancer, has been seeing Dr. B. at least once per month for 2 years, and now she is dying. If asked, Dr. B. would acknowledge that “see you later” is not quite true; he doesn't actually think he will ever see her again. Dr. B. intends to be casual and cheerful, but he is missing an opportunity to acknowledge with Ms. White that their relationship is ending.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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