On Saying Goodbye: Acknowledging the End of the Patient–Physician Relationship with Patients Who Are Near Death
Authors: Anthony L. Back, Robert M. Arnold, James A. Tulsky, Walter F. Baile, Kelly A. Fryer-Edwards
Journal: Annals of Internal Medicine (2005)

Medical Writings: Words That Make a Difference19 April 2005On Saying Goodbye: Acknowledging the End of the Patient–Physician Relationship with Patients Who Are Near DeathAnthony L. Back, MD, Robert M. Arnold, MD, James A. Tulsky, MD, Walter F. Baile, MD, and Kelly A. Fryer-Edwards, PhDAnthony L. Back, MDFrom University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1023; University of Pittsburgh, Pittsburgh, PA 15213-2582; Durham Veterans Affairs Medical Center and Duke University, Durham, NC 27705; University of Texas M.D. Anderson Cancer Center, Houston, TX 77230-1402; and University of Washington, Seattle, WA 98195., Robert M. Arnold, MDFrom University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1023; University of Pittsburgh, Pittsburgh, PA 15213-2582; Durham Veterans Affairs Medical Center and Duke University, Durham, NC 27705; University of Texas M.D. Anderson Cancer Center, Houston, TX 77230-1402; and University of Washington, Seattle, WA 98195., James A. Tulsky, MDFrom University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1023; University of Pittsburgh, Pittsburgh, PA 15213-2582; Durham Veterans Affairs Medical Center and Duke University, Durham, NC 27705; University of Texas M.D. Anderson Cancer Center, Houston, TX 77230-1402; and University of Washington, Seattle, WA 98195., Walter F. Baile, MDFrom University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1023; University of Pittsburgh, Pittsburgh, PA 15213-2582; Durham Veterans Affairs Medical Center and Duke University, Durham, NC 27705; University of Texas M.D. Anderson Cancer Center, Houston, TX 77230-1402; and University of Washington, Seattle, WA 98195., and Kelly A. Fryer-Edwards, PhDFrom University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1023; University of Pittsburgh, Pittsburgh, PA 15213-2582; Durham Veterans Affairs Medical Center and Duke University, Durham, NC 27705; University of Texas M.D. Anderson Cancer Center, Houston, TX 77230-1402; and University of Washington, Seattle, WA 98195.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-142-8-200504190-00033 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Ms. White is being discharged with home hospice after an admission for malignant bowel obstruction. Her physician, Dr. B., has come by on rounds and has finished answering her questions. He is finishing up his encounter: "Well, it sounds like everything is ready for you at home, and I'm glad you're feeling better. You'll be in good hands with hospice. I'll see you later."Ms. White, a woman with metastatic colon cancer, has been seeing Dr. B. at least once per month for 2 years, and now she is dying. If asked, Dr. B. would acknowledge that "see you later" ...References1. Lo B, Quill T, Tulsky J. Discussing palliative care with patients. ACP-ASIM End-of-Life Care Consensus Panel. American College of Physicians American Society of Internal Medicine. Ann Intern Med. 1999;130:744-9. [PMID: 10357694] LinkGoogle Scholar2. Quill TE. Perspectives on care at the close of life. Initiating end-of-life discussions with seriously ill patients: addressing the "elephant in the room". JAMA. 2000;284:2502-7. [PMID: 11074781] CrossrefMedlineGoogle Scholar3. Bedell SE, Cadenhead K, Graboys TB. The doctor's letter of condolence. N Engl J Med. 2001;344:1162-4. [PMID: 11302139] CrossrefMedlineGoogle Scholar4. Irvine P. The attending at the funeral. N Engl J Med. 1985;312:1704-5. [PMID: 4000217] CrossrefMedlineGoogle Scholar5. Mount BM. 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[PMID: 11401612] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1023; University of Pittsburgh, Pittsburgh, PA 15213-2582; Durham Veterans Affairs Medical Center and Duke University, Durham, NC 27705; University of Texas M.D. Anderson Cancer Center, Houston, TX 77230-1402; and University of Washington, Seattle, WA 98195.Acknowledgments: The authors acknowledge all of the fellows who have participated in Oncotalk retreats over the past 3 years, the amazing actors who have shown us the power of goodbyes, and Holly Prigerson, PhD, for helpful conversations about empirical studies examining grief.Grant Support: By the National Cancer Institute (NCI R25 92055).Disclosures: None disclosed.Corresponding Author: Anthony L. Back, MD, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, Box 19023, Seattle WA 98109-1023; e-mail, [email protected]washington.edu.Current Author Addresses: Dr. Back: Seattle Cancer Care Alliance, 825 Eastlake Avenue East, Box 19023, Seattle, WA 98109-1023.Dr. Arnold: University of Pittsburgh Medical Center Montefiore Hospital, 200 Lothrop Street, W933, Pittsburgh, PA 15213-2582.Dr. Tulsky: Durham Veterans Affairs Medical Center and Duke University, 508 Fulton Street, Durham, NC 27705.Dr. Baile: University of Texas M.D. Anderson Cancer Center, Unit 431, Box 301402, Houston, TX 77230-1402.Ms. Fryer-Edwards: University of Washington, 1959 Pacific Avenue, Seattle, WA 98195. 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