Abstract
I entered medical school intending to pursue family medicine but once in the field grew weary of the struggles of managing an office and the pressures to be more productive. Increasingly, I found it difficult to practice medicine the way I was trained. My time with patients was limited. It seemed I was frequently battling with insurers; my enjoyment of the work fell. Patients angry over rising copays and insurance limitations would frequently vent their frustration at my staff or me. I became uncomfortable by what I considered the intrusion of private insurers into my relationship with the patients. It was not unusual for patients to decline to provide their medical history, fearing they might lose their insurance.
I initially became involved with our local hospice as a second income to make ends meet in my office. I was lucky to join a wonderful team and find a mentor physician. Soon, I found I was looking forward more to my work at hospice. Clearly, it was time for a change.
I had always hoped to incorporate holistic medicine in my work as a physician, and hospice meets that interest in many ways. I enjoy the collaborative team approach of care with an emphasis on the whole person from the medical, spiritual, and social perspectives. It allows me to use my training as a family physician: approaching the patient in the context of the family, providing comprehensive care. Although I had several partners at my former practice, there was almost no time to discuss a difficult diagnosis or share insights. The team approach in hospice allows for these discussions.
The longer I have been in medicine, the more I understand that listening is the most important thing I do as a physician. Hospice care allows me to spend time with the patients, using my skills of listening, a critical consideration when I chose to work in this area. In my previous practice the demands of productivity made medicine feel more like running on a treadmill. I am grateful to have found something that suits me better. Hospice has allowed me to practice medicine on my own terms, something I found lacking in my private office.
I am also excited to be part of a new specialty, a pioneer in the medical world. The field of hospice and palliative medicine was not an option when I was a student, a testament to the rapidly changing nature of medicine. In retrospect, I do not recall a single lecture from medical school on the topic of hospice or the provision of palliation. It is an area I stumbled into on my own. After caring for one elderly gentleman through a 6-month hospitalization during which every organ system eventually went into failure; I found myself questioning much of what I had been taught. I knew I would not want to die in that manner nor would I want that for a loved one.
In my work with hospice, I have found patients are relieved to know they have another choice when they reach the terminal phase of disease. I credit many of my patients for teaching me that dying is not a failure but rather a natural transition. I only wish I had known of this approach during my medical training. I frequently tell students wishing to pursue medicine that there are numerous options available; each must find his/her own niche. It seems I have finally found mine.