I got a call from a long-lost high school friend a few days ago who wanted me to explain hospice to him. I obliged and explained what we do, the team concept, and that type of stuff, and then he asked me if we ever accept patients who are not terminally ill. I explained that part of being certified as eligible for hospice is that you have a diagnosis of six months or less to live “given normal disease progression”. Then he explained why he had called.
It seems that this friend has a client who has been put on hospice, but the client and client’s family doesn’t think he has a terminal illness. According to them the doctor has told them that he doesn’t think there is anything wrong except that the patient has become addicted to morphine. No cancer, no real diagnosis to speak of.
I’m going to put aside my questions about how the hospice admitted him and focus on the doctor at this point, because this is a problem that I’ve faced many times. It is not the hospice’s responsibility to tell a patient that they are terminally ill. I have casually mentioned during admission the fact that we work with people with a terminal illness and seen patients and families faces register shock because it is the first time that they have heard that the illness is terminal. Most of the time this is the first time I have ever met these people, and I am horrified that I, a complete stranger, am breaking the news. I don’t have answers to the questions that come next, because I’m new to the case.
All of this is to tell any doctor that may read my rants that it is better for the patient if you go ahead and tell them the real story. Be honest. They are going to find out, and it’s best if they find out from someone they trust instead of finding out from a stranger.
My friend called back after talking to his client (thus my friend was the person to tell him that he was terminal) and wanted to know if the client would be financially responsible for hospice care if he doesn’t die. Assuming that he does have a terminal illness, this guy needs to be focusing on living out his final days. He needs to finalize his will, say the things that need to be said. . . Instead he’s worried that he’s going to be stuck with a bill, because he doesn’t believe he’s terminal. Why does he not believe it? Because nobody who has the anwers has had the guts or the time to tell him the truth. Whatever the reason, this situation is inexcusable and more common than anyone wants to admit.