BravoDotCom

[deleted]

Thanks for the replies and your personal experience. I know that given that I'm inpatient only I have a higher likelihood of seeing patients who 'failed' outpatient, if that makes sense.

Agree with what was said earlier, some patients have the expectation that they are there to get stronger to get more chemo, however in the chart the Onc is documenting "there are no further treatments". I don't like to step on toes but I also am under pressure by the rest of the care team to a) change the code status b) family meeting to reset expectations c) discharge and not just let sit over the weekend until the Onc comes back and maybe help with a talk on prognosis.

I know they need to be positive but it is more common than not that I am the one who says: "your doctor sent you here for symptomatic care but does not feel any further treatments are available or that you will tolerate". If I don't do it, I feel it's unfair to send PC and Hospice reps in the room because I feel the patient needs to know "why" they are coming in to talk.

My frustration is that the Oncs feel that it is the role of Hospice and PC to get the patient on hospice, but the reasons why (other than 'we focus on comfort, you want to be comfortable don't you?') are not discussed with the patient in depth (ie "because we feel that there are no other treatments").

I see this happening, so I always throw myself in the middle and be the "bad guy"...else I feel the patient leaves the hospital under the wrong pretenses about what hospice care means. They keep getting readmitted with the same plan of care of "to feel better until my next treatments".

I guess just realize that this happens at my institution, and I'm currently enroute to my grandfathers funeral where this happened to him. So I don't think it's unique to my location, and may be occurring at your home institution. This may be where a lot of patients and families are falling through the cracks, where help may be needed and currently lacking. Your Hospitalists may be having similar frustrations and patients may be pogo-ing back and forth since Hospitalists, by definition, do not have long standing relationships with patients and thus feel uncomfortable admitting a patient then having the end of life talk everyone else is documenting in the chart.