Things they didn’t teach in medical school: Part 23 Saying goodbye to patients

One of the things I haven’t quite got the knack of is saying goodbye to patients. I’ve recently looked after two young women the same age as myself. Both with children similar ages

In my job as an oncologist I often establish long-term relationships with patients. These relationships can span years and involve periods of fortnightly visits, stays in hospitals, and the roller-coaster ride of good and bad news. Some of these patients genuinely considered to be friends.

Unfortunately, as is the case for cancer and a lot of other diseases, the inevitable end comes. With years of experience doctors becoming increasingly good at predicting the time to end-of-life. The reality is that I know that sometimes when I am consulting with a patient, either in the rooms or on a ward, it will be the last time I see them alive or in some cases the last time I will be able to talk to them. In some cases I know they are going to hospice and won’t return.

I’m sure that the patients often know as well but nonetheless we do the dance, “I’ll see you tomorrow” or “make an appointment for two weeks”. It is an opportunity for imparting hope but a lost opportunity for saying goodbye.

In Annals of Internal Medicine (2005: 148(8), p. 682) Anthony Back offers a list of tips around saying goodbye:

(1) Choose an apropriate time and place
(2) Acknowledge the end of routine contact and the uncertainty about future contact
(3) Invite a response and use it as data about the patient’s state of mind
(4) Frame as an appreciation
(5) Give space for the patient to reciprocate and respond empathetically to the patient’s emotion
(6) Articulate ongoing commitment to care

Like most of these communication experiences it is important to practise and to remember to remember that communication is jazz – you will have to improvise.

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