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On the Other End of the Stethoscope

Erik Fromme, MD; J. Andrew Billings, MD

JAMA. 2003;290:2048-2055.

The challenges of caring for a dying doctor reflect both common issues in helping the terminally ill and unique problems in working with a physician-patient. The dying doctor must deal with a familiar environment and set of problems from a radically different perspective and must negotiate overlapping and conflicting personal and professional roles. Some of the cardinal virtues of physicians—professional identity, expertise, perfectionism, selflessness, and stoicism—may pose both strengths and liabilities in the patient's role. The treating physicians may also encounter new strains in caring for a colleague. They must guard against both overinvolvement and underinvolvement, and, as with all dying persons, they must serve as a guide through unfamiliar territory for dying patient and family—a companion who is not afraid to listen to or explore the most upsetting matters, a person who can speak frankly when others may be ignoring "the horse on the dining room table." The case of Dr B, an internist dying of myelofibrosis and congestive heart failure, whose son is also a physician, offers the reader the opportunity to reflect on these challenges and to draw lessons about how to best care for fellow physicians at a time of great need. We suggest strategies for negotiating the patient-physician relationship when the patient is also a physician.

Author Affiliations: Massachusetts General Hospital Palliative Care Service and the Harvard Medical School Center for Palliative Care and Oregon Health and Science University; Palliative Care Service, Massachusetts General Hospital (Drs Billings and Fromme) and Center for Palliative Care and Department of Medicine (Dr Billings), Harvard Medical School, Boston, Mass. Dr Fromme is now with the Department of Medicine and Center for Ethics in Healthcare at Oregon Health Sciences University and Center for Ethics in Healthcare.

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