Portal de Periódicos da CAPES

Retiring with Compassion

2009; Wolters Kluwer; Volume: 31; Issue: 9 Linguagem: Inglês

10.1097/01.cot.0000352160.80497.52

1548-4688

Wendy S. Harpham,

Ethics and Legal Issues in Pediatric Healthcare

The time will come for every physician when he or she retires from practice. As with every other aspect of patient care, doing it well serves our mission of healing. In the spring of 1991, with my first course of chemotherapy winding down, I made a business decision: If my cancer recurred, I'd close my practice. As a solo practitioner, the financial hit of months without income was too great to repeat. Besides, my patients deserved better than a doctor who takes long medical leaves. So when my lymphoma recurred soon after resuming work, closing my practice was automatic. Given the tumult of adjusting to the terrible news, celebrating the publication of my first book, and beginning radiation therapy, I thought I did a pretty good job by sending out a “Dear Patient” letter informing them of my illness and instructing them to have their records transferred. Only today do I realize how I could have done it better. You see, yesterday my internist called to let me know she's closing her solo practice. My body flushed, the way it does when I get unexpected, unwanted news that I immediately know is immutable. Although not 100% surprised, I felt momentarily shocked by the announcement I'd been hoping wouldn't come for another few years. This morning, since I was at the hospital anyway for Grand Rounds, I decided to swing by my internist's office to get the ball rolling regarding my records. I walked up to her sign-in desk as I've done dozens of times before. Her receptionist, Judi, and I looked at each other, blues and browns instantly welling up. Just then, my internist appeared out of nowhere to place a chart on Judi's desk. I tried to stay strong. But I couldn't stop the tears and surrendered to my internist's grip on my arm as she opened the door to her private office and ushered me in. I didn't cry while being evaluated or treated for my last three or four cancer recurrences; yet now I feel bereft. This unexpected blast of grief implores me to figure out why. For cancer patients, finding a new physician and rehashing years' worth of medical problems and treatments is no picnic (especially for the elderly). But nothing worth crying about. What hurts so much is having to move on without you. You cannot underestimate the power of the connection your patients may feel. For many, you are their lifeline—even their hero. You guided them through defining moments, if not the saddest and most frightening experiences of their lives. You gave them hope. Life and death are woven into the fabric of your everyday work. But for patients, cancer is a life-and-death crisis. Receiving chemo or radiation or investigational therapy is anything but routine. Like riders squished together as a carnival's teacup ride spins ‘round and ’round, your patients feel pulled into you by the momentum of survivorship. Throughout the ride, and even long after treatment ends, your patients' gratitude for your efforts can be like glue that binds you two together. Joni Mitchell sings, “You don't know what you've got ’til it's gone.” As a survivor, I'll tell you “it ain't necessarily so.” Because oftentimes cancer only threatens to take some things away—or takes some things away, but only temporarily. Believe me, we survivors do know what we've got, every second we have it. Since my first visit I appreciated my internist's skills. Since figuring out her style and routine, I valued my ability to help her help me. For years I savored the intimacy of her knowing my fears, hopes and loves, and I enjoyed the relief that came with trusting completely that she cared. This trust grew through the early years of setbacks and victories, things gone wrong and things gone right, and my certainty that we both did our best. So it would be silly to suggest that today I suddenly appreciated my physician. No, today I realized the magnitude of how special—and difficult-to-replace—our relationship was. And with this insight, the wall crumbled that had been protecting me from feeling my patients' pain. I now empathize with the woman who bumped into me recently at an airport and said, “I still miss you as my doctor.” Because the truth is that while I enjoyed rich and meaningful relationships with hundreds of patients like her, she had only one me. But how could anyone have expected me to acknowledge my patients' loss when I closed my office? I was too sick. I was too devastated by my recurrence and losing my practice. Yesterday my internist anticipated my concern for her by saying up front, “I'm not sick.” All I had to do years ago was add a sentence to my “Dear Patient” letters— “I'm getting excellent care”—to acknowledge their concern for me and to reassure them. If you are fortunate enough to retire on your 80th birthday (as I'd promised all my patients), I hope you tell them how excited you are about reading books or traveling, so your patients have positive feelings about your future. One of your last acts as a clinician is helping your patients transfer their records to other physicians. If you can, offer a list of physicians, too, and suggest a few individuals who might be a good match. Boost your patients' confidence by reminding them they'll never really be a “new patient” again because of all they've learned while under your care. And before you sign off, either in a letter or on the phone, please do what my internist did for me: Tell them how caring for them has been an honor. God how I wish I'd said that, and how much I was going to miss them. Sharing the grief with your patients may make the moments of leaving your practice more painful, but it can begin the healing for your patients. And for you. Now Available: Wendy Harpham's Newest Book Wendy Harpham's newest book, Only 10 Seconds to Care: Help and Hope for Busy Clinicians, has now been published by ACP Press, the book publishing program of the American College of Physicians. In this book, her seventh, Dr. Harpham shares insights and advice about the healing power of compassionate words and actions that take only seconds to say or do, yet can make a world of difference to patients.FigurePatricia Ganz, MD, Professor of Health Services at UCLA Schools of Medicine and Public Health, who teaches Health Care Practices and Variations and Ethical Issues in Public Health, calls the book “a must-read for physicians-in-training, as well as for seasoned clinicians,” noting that Dr. Harpham's insights into the clinician-patient relationship “are funny, accurate, and sometimes painful.” The book (ISBN 978-1-934465-39-4, softcover, 198 pages) is now available in bookstores and on Amazon as well as from ACP at www.acp.org/acppress or by phone at 800-523-1546, ext 2600.