The Dying Patient: Some Questions

It would be unusual for the patient's personal physician to be attending and witnessing the imminent death of his or her patient. Usually, that physician is somewhere else at the time and it usually is the family, attending nurses, pastor, hospitalists or paramedics who actually are present and attending to the patient. However, often, it is in the day or days before death that the personal physician has the opportunity to be present and therefore be able to professionally interact with the dying patient. But what should be that interaction?

The issue of the dying patient is an important topic that is discussed with medical students as they begin their medical education and their careers. At the medical school in which I participate, we talk about the dying patient in the first semester of the first year. The students are given the opportunity to sit with and talk to an actor (standardized patient) playing the role of a dying patient and then later are given feedback regarding their behavior by both the “patient” and the physician facilitator. Further, I give my students a series of questions to answer and which becomes the basis for a small group discussion regarding the role and responsibilities of the physician dealing with the dying patient. The students may each have different answers to some of the questions, perhaps based on their own personal experiences and these differences are discussed.

The public’s view of the role of the physician attending the dying patient may be different than any consensus arrived at by a group of students learning to become doctors. I would like to present these questions to my blog visitors and then read and learn how they would answer them. As I have noted in previous posts, a physician's role in medicine is often set by society and my visitors represent that society. ..Maurice.

1. What do you think is the physician’s role in dealing with the dying patient?
2. Do you think there is a time when the physician should back away and let the nurses, family and pastor deal with the patient?
3. What do you think a physician feels when he/she stands at the bedside of his/her dying patient? Is there any “right: or appropriate feeling?
4. Should a physician tell his/her patient that he/she is dying? Why or why not?
5. What should the physician be talking about to his/her dying patient?
6. What is the role of a bedside physician when his/her patient has just died?