When I realized that I would be moving to a different county within Southern California and would have to change jobs, I knew it would be inevitable that I would have to say goodbye to my patients. I was dreading this. I mean, really dreading it. I don’t like goodbyes. I feel as though I am breaking up, and in a way I am. Like any other relationship, my patient-physician relationships are coming to an end. And breaking up is always hard to do.
I know as a doctor I am supposed to refrain from getting attached to my patients. But how is that possible, I mean really? I am human after all. I have been taking care of these patients for three years now. I have seen them routinely, perhaps more than some of my own family members. I have been taking care of them, their kids, their spouses, and their grandparents. I have gotten to know what their hobbies are, what they are afraid of, and perhaps their deepest darkest secrets. I have laughed with them. And yes, I have even on occasion cried with them.
I broke the news to one of my patients today. And she started to sob. I mean really sob, with a fountain of tears. I didn’t know what to say or what to do, except to hug her and tell her I am so sorry. I felt as though I was abandoning her. It was difficult, I tell you. I reassured her that she will surely find another physician that she will connect well with.
In the end, I didn’t regret telling her, however. I knew that she needed to know, no matter how difficult it would be. I have heard of physicians leaving without saying goodbye. And I do understand why. It is because it's not easy to say goodbye, whether we admit it or not. It’s awkward, unsettling, and emotional. Physicians aren’t 'supposed to' get emotional. It would certainly be much easier to sneak away without having to face my own and my patients’ emotions.
But no matter how difficult, I have to say my farewells. It is just the right thing to do, and for several reasons:
Insurance Lead: Many insurance programs require you to select a primary care doctor. If I don’t tell them that I am leaving, they will fall behind in this process and may even be randomly assigned. In saying goodbye, I can give them the heads-up so that they can start looking for a new PCP, instead of being randomly assigned to a physician that they may not connect well with.
Sign-Out: I know them well, I know their health issues, and I know their personality. In this way, I also know who they may “match-up” well with. I can give them a few names of physicians that I think they would connect well with, so that they are not left out in the dark. I care about my patients and I want them to be well-taken care of after I leave.
Closure: Some of my patients may feel as though I have “abandoned” them after I leave if I don’t give them a heads-up. I would feel very uncomfortable if they were to feel this way. They need closure, and so do I. Like any other relationship, I have to tell them so that we can both move on in a healthy mature manner.
Pre-Preparation: When they meet their new doctor for the first time they need to be prepared. They need to bring all their medication bottles, a list of their health problems, and mentally they need to be ready to re-establish from scratch in case their new doctor has questions. If I don’t say goodbye, I will have robbed them of this pre-preparation period. They need to be ready.
Ethics: Like any other relationship, it deserves an exchange of communication from the two sides. Physicians are professionals, and providing this closure for our patients is the ethical way to handle it. It’s just the right thing to do.
And with that, I sadly say farewell…
(Until my next blog entry, of course)
6 comments:
Patients dread saying goodbye to their doctors too. It just about killed me to say goodbye to my surgeon after going through four breast cancer surgeries with him. It's nice to know it works both ways. Your patients were very lucky to be under your care.
It sure does work both ways. Doctors are human too -- even if we try to "hide" our emotions, believe me, we do feel. Thank you for your kind words, Jackie :)
"I know as a doctor I am supposed to refrain from getting attached to my patients. But how is that possible, I mean really? I am human after all. I have been taking care of these patients for three years now."
Dr JAT, You KNOW you don't believe the above comment about "refrain from getting attached". In family medicine, We are SUPPOSED TO GET ATTACHED to our patients. That is the definition of compassion. That is what separates our specialty from many others.
A phony separation from the humanity of the patient can hurt the patient (and doesn't say much for the doctor). I agree with what you know in your heart to be true and your actions. The apology for someone else's dogma about "don't get attached to patients" wasn't needed since you know that teacher wasn't a family physician and anyone who believes it isn't a family physician either.
Thanks for going with your heart instead of a poor faculty from another specialty. You have compassion- that's why it hurts to leave your patients. If you can't hurt, you can't care! You care deeply! Thank you for being a family physician.
Dr. Synonymous, i stand corrected! You are right in that family physicians surely have the reputation to be more compassionate than other specialties, in general. Although i have met some very kind specialists as well. Your patients must be so lucky to have you as their doc! Thank you for your kind comments :)
After reading your entry, now I don't feel so bad about having burst into tears when my FP doctor told me he was leaving!! I was so embarrassed but couldn't help it.
It wasn't so much that we "knew" each other--I didn't see him very often--but because he filled a deep need in me, never fulfilled by previous docs, to have a PCP who listened, examined, thought, and looked things up BEFORE he started talking and making decisions or recommendations. I don't need a doctor who "cares about me as a person," but one who cares deeply about getting the diagnosis and the treatment RIGHT--by LISTENING and using history, logic, and resources. Many doctors make quick, unwarranted ASSUMPTIONS about you or your history/symptoms and end up getting things wrong and leaving the patient frustrated.
I've had to harden my own heart--so I won't be crushed AGAIN when the next doctor makes all those unwarranted assumptions about a middle-aged female with a somewhat odd history. My former PCP was a shining exception. (I will say that FP doctors seem much better than snooty internists!)
I also appreciated your tips about seeing a new doctor for the first time. I was already preparing a summary and was glad to see I'm on the right track! Thanks for your entertaining and informative posts!
Unknown, you are so welcome! I am glad you found my posts helpful in any small way. No need to ever be embarrassed about having made a connection with your doc! That's how it should be! I hope you find that connection again with your future docs, too :)
Thanks for reading,
Jill
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