Giving Patients the Choice: A Doctor’s Perspective

“There’s nothing more fulfilling than seeing that your patients and their families are happy with the care they’re receiving,” explained Dr. Nwando Tony-Onugu, second year internal medicine resident at Bayhealth Hospital in Delaware.

And thanks to an eye-opening hospice rotation in partnership with Delaware Hospice, Dr. Tony-Onugu has a new perspective on how to ensure her patients are receiving the kind of care they want. Because one of the biggest regrets of families who receive hospice care is that they didn’t learn about hospice sooner.

During her time at Delaware Hospice, Dr. Tony-Onugu spent time in the Delaware Hospice Center in Milford, as well as doing home visits with Delaware Palliative and Delaware Hospice home care teams. She was not only impressed by how happy and at ease the patients and their families were, she was amazed by the resources available through palliative and hospice care—resources that physicians outside the palliative and hospice field often don’t have access to or even know about.

After her hospice rotation, Dr. Tony-Onugu realized that many of the patients she repeatedly manages on the floor meet the criteria for hospice care, including those with end-stage heart failure. While Bayhealth has an onsite palliative team to consult with when it becomes clear that it’s time to redefine a patient’s care goals, Dr. Tony-Onugu is resolved to having more of those hard conversations with her patients herself, early and often. Why?

1. The best doctor-patient relationships are open and honest.

Nobody likes to talk about things like death. But having those hard conversations is the only way that patients can truly understand what the progression of their condition looks like—and make a fully informed choice about the kind of care they want. Those hard conversations are a little bit easier when they’re with a doctor the patient already knows and trusts.

2. Palliative and hospice care offer resources that improve patients’ quality of life.

The typical medical approach of making the patient feel better and sending them home can often result in a cycle of hospital admissions for patients with serious or chronic conditions. Through palliative and hospice care, pain and symptoms can often be managed via home visits, avoiding unwanted time in the hospital. Access to social workers, counselors and more, further ease the burden of patients and families facing serious or terminal illness. But patients can only access the wealth of resources available through palliative and hospice care if they know this type of care is available to them in the first place.

3. The doctor-patient relationship ends when a patient dies, but hospice care offers families longer-term support.

While a doctor might call and offer their condolences to the family of a patient who has passed, their connection ends there. Dr. Tony-Onugu is encouraged by the idea of a family’s ability to receive ongoing bereavement support through hospice programs like Delaware Hospice. Without connections to a hospice program, these families are left to face their grief journey on their own.

Conditions like end-stage heart failure aren’t getting cured. Treatments for a serious illness like cancer aren’t pretty. Exactly what that means can be hard to hear as a patient or to describe as a doctor. But the more open and honest our conversations are, the better a patient can take control of their life and live it the way they choose—including with support from palliative or hospice care. The new palliative and hospice rotations for Bayhealth’s resident doctors are a tremendous step forward in helping us get there.

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