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On Saying Goodbye: Acknowledging the End of the Patient–Physician Relationship with Patients Who Are Near Death

Anthony L. Back, MD; Robert M. Arnold, MD; James A. Tulsky, MD; Walter F. Baile, MD; and Kelly A. Fryer-Edwards, PhD
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From University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1023; University of Pittsburgh, Pittsburgh, PA 15213-2582; Durham Veterans Affairs Medical Center and Duke University, Durham, NC 27705; University of Texas M.D. Anderson Cancer Center, Houston, TX 77230-1402; and University of Washington, Seattle, WA 98195.

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, tonyback@u.washington.edu.

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.

Ann Intern Med. 2005;142(8):682-685. doi:10.7326/0003-4819-142-8-200504190-00033
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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.”

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Posted on April 25, 2005
Khaleel Ashraf
Conflict of Interest: None Declared

As a Hematology-Oncology fellow with a continuity clinic at our VA Hospital, I had the privilege to take care of several veterans, from whom I have learned a great deal on the the art and science of practising oncology. One of the hardest things for me as their physician was to say good bye, when we could not help them any longer. I thank and congratulate the authors for this wonderfully written article.

Conflict of Interest:

None declared

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