 | Tom Welk
DMin is Director of Pastoral Care & Professional Education at Harry Hynes Memorial Hospice. He also teaches at the University of Kansas School of Medicine-Wichita. He has certification with the American Association of Pastoral Counselors in Clinical Pastoral Education. His memberships include Park Ridge Center for Study of Health, Faith, and Ethics, and St. Louis University Center for Health Care Ethics, Charter Board Member Kansas Health Ethics, Inc., and Ethics Committee Member for National Hospice Organization. He has received the President's Award of Excellence for Public and Community Awareness, for the "Dying Well" project from The National Hospice Organization. Tom's group presentations include: Association of Kansas Hospices, Midwest Congress on Aging, and Kansas Health Ethics Conference. Tom Welk can be contacted by fax at (316) 265-6066, by e-mail at: twelk@hynesmemorial.org, or at his office at (316)219-1791. |
Hospice
2003-08-01 11:28:00
Patient/Doctor relationships
: My uncle needs hospice. He is concerned, however, that his doctor will no longer be able to see him. Is this true? Can one's doctor continue a patient/doctor relationship when that patient is in hospice?
ANSWER: Patients under the care of a hospice program definitely are able to continue to be cared for by their physician. The hospice program will rely on the patient's physician to oversee the medical care. The hospice nurses will work with that physician to whatever extent he or she wishes. When these nurses visit the setting in which the patient resides, they become the doctor's "eyes and ears," and fully communicate to the physician what they see and hear. The doctor can then respond with the appropriate orders to ensure the patient is cared for in the best way possible. Furthermore, hospice can only take a patient under care when that patient has been specifically referred as appropriate by a physician. Being "appropriate" for hospice services means that in the best, reasonable judgment of a physician the patient has a prognosis of six months or less. Because of the involvement of a number of physicians in the care of a patient, it sometimes is difficult to determine which physician should make the actual referral to hospice. If the patient is under the care of a specialist (cardiologist, oncologist, etc.), it is the specialist who generally determines whether the patient is likely to benefit from further aggressive curative treatment. When the medical judgment is made that this is not the case, then the patient will be directed to the care of a hospice program. The actual referral to hospice can be made either by the specialist or the patient's attending (family) doctor. The patient/family will also be involved in the decision as to which doctor they want hospice to work with during the patient's final days. Some hospice programs also have doctors who are part of their staff, and are available to consult with the patient's referring physician on pain control and symptom management. They are also available on a full time basis for the hospice nurses as they provide the daily hands-on physical care for the patient and other hospice staff (e.g., social workers and chaplains) who provide the psychosocial/spiritual care. Even if a hospice program does not have a doctor on staff, it is still required to have a medical director(s) whom it can contact. These medical directors have their own practices, and will be available to the hospice program on a consulting basis as needed. In the event that a patient does not have his/her own doctor the physician on the hospice staff or the medical director who is available as needed can become the hospice patient's attending physician.
