Medical care of the dying patient

The vast majority of Americans die in hospitals or in nursing homes. Al-though doctors and hospitals can provide state-of-the-art curative medical care, they are often ill-equipped to work with the dying patient. As a result, dying patients suffer needlessly from uncontrolled symptoms including pain, dyspnea, nausea and vomiting, and agitation. In addition, family members are often excluded from the care of the patient, and the natural process of death becomes an alienating and anger-provoking event

Hospices can provide an alternative approach to the care of dying patients Typically, hospices consist of an interdisciplinary team of nurses, social workers, chaplains, and others, who provide services in the patient's own home. Hospice care is covered by Medicare, as well as most state and commercial insurance plans

Physicians can be effective in working with hospices to provide humane care to dying patients. The first key step is to accurately establish the diagnosis and prognosis for the patient, anticipating the likely complications which will occur. The second step is to assess and relieve the patient's major symptoms Fortunately, we currently have the ability to relieve most terminal symptoms such as pain and dyspnea very effectively. Finally, physicians must elicit the values and beliefs of the dying patient and family and attempt to honor them whenever possible

Death is inevitable, and most people fear that the end of life must be associated with pain and indignity. There is considerable public anger regarding the role of physicians in perpetuating this situation. Physicians can do much to correct this situation by making greater use of hospices', and utilizing the principles of care outlined in the article