Thursday, August 19, 2010
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)