The physician's role is to determine the patient's desires and to comply with them in a fashion that is least likely to be uncomfortable for the patient. Unlike physicians, most patients and family members have never seen anyone die, so it is the physician's responsibility to inform the patient and family about death, describe realistic scenarios of what is likely to happen, provide reassurance, and provide advice on the setting that is most compatible with their tolerance for this experience. The educational resource document of the American Board of Internal Medicine on care of the dying patient is an important resource addressing the issues encountered in the care of terminally ill patients. Patients who suffered from anxiety or personality disorders or who otherwise had poor coping skills before becoming ill can also make the terminal phase of illness more difficult for themselves, the family, and the physician and may require psychiatric intervention. These patients can be a test of a physician's interpersonal skills, but even the most skilled physician will find such patients may abruptly seek other physicians or avenues of care.
Hospice care is available in many communities.
A hospice can be viewed as a concept of care or as an institution that provides an integrated program of trained professional and volunteer support for dying patients. It is the attention to the overall physical, emotional, social, and spiritual needs of the patient and family members that characterizes the concept of hospice. Patients for whom disease-oriented treatment is no longer desired or appropriate and who have a life expectancy of six months or less are candidates for hospice care. The elements of such care have traditionally been embodied in almost all communities, although perhaps not institutionalized in a hospice. The hospice can be a free-standing facility or a ward in a hospital, but today most are visiting programs offered in the homes of patients and consist of a coordinated effort that includes health professionals, clergy, home health aides, social workers, and volunteers.