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On Being a Doctor |

Living Wishes

Adam B. Possner, MD
[+] Article and Author Information

From Johns Hopkins Bayview Medical Center, Baltimore, MD 21224.


Requests for Single Reprints: Adam B. Possner, MD, Medical Faculty Associates at George Washington University, 2150 Pennsylvania Avenue NW, Suite 2-105 South, Washington, DC 20037; e-mail, apossner@mfa.gwu.edu.


Ann Intern Med. 2010;153(11):761-762. doi:10.7326/0003-4819-153-11-201012070-00012
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I had barely shaken her hand before Ms. Williams cut to the chase. “Doc,” she declared in a hoarse voice surprisingly large for her size, “I haven't always followed up, but I'm gonna follow up now.”

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Myths and misconceptions on hospice care
Posted on January 6, 2011
Andrea K Bial
Horizon Hospice and Palliative Care
Conflict of Interest: None Declared

It was refreshing to read Dr. Possner's essay on caring for a young woman dying of cervical cancer. His compassion, dedication, and commitment (including doing home visits while still in residency) are quite commendable. However, according to him, his experience taught him that he should not have "pushed so hard" to obtain a DNR and a hospice consult. As a result, the patient died in an ER after paramedics were called to her home where she lived with her young son and husband. His conclusion unfortunately exemplifies the common myths and misconceptions concerning hospice and palliative care in this country, and I fear that this "lesson" it has given him will only further propagate these fallacies. First and foremost, DNR is not required for any hospice consult or even hospice admission. The conversations about these two decisions, while sometimes held simultaneously, are also frequently addressed days or weeks apart. Second, Dr. Possner does not really give the credit due to the palliative nurse (ironically insisted upon by the insurance company; why had no other healthcare providers, whether Dr. Possner or his supervising attendings, thought to involve a palliative care team?). It was only after she saw the patient that the patient's dying wish--to get married before dying-- was known and granted, just days prior to her death. It is imperative that all healthcare providers understand that such questioning--on patients' goals in whatever remaining time they have--is a key aspect of hospice and is addressed by nurses, social workers, volunteers and chaplains. Dr. Possner was very, very lucky. I am not sure he is aware of his luck. His comfort in his patient being able to get "what she wanted out of life" was due to the nurse, not to him. Finally, by associating hospice with DNR, and failing to achieve both, Dr. Possner unfortunately prevented his patient's family members of the opportunity to form relationships with a healthcare team that could have helped them through the entire dying process, and perhaps even more importantly, through the bereavement process. Many of those in the health care field do not realize that hospice cares not only for the patient, but for all those involved in the patient's care.

Conflict of Interest:

None declared

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