The attending physician is the patient’s primary medical doctor, provides medical services throughout the course of the illness, and is an integral part of the hospice team.
“Many services are available that help the patient. Hospice is an excellent support to the physician who no longer has to try to coordinate all the cares of the dying patient.”
-Liz Osborne, M.D.
Family Practice
How to Refer to Hospice
An initial referral to hospice always begins with an honest discussion with the patient about care and treatment options.
Once this has occurred, a hospice program will ask for the following information regarding the patient:
- admitting diagnosis and prognosis
- current medical findings
- orders for medications and treatments
- patient and family understanding of disease and prognosis
- relevant patient and family information
- history and physical
- order for hospice care
“Hospice is an invaluble resource because a team approach allows for broader patient cares both physical and emotional. Communication is an important part of the team.”
-John Scanlon, M.D.
Internal Medicine
Ongoing Care
Once the patient is enrolled in a hospice program, the attending physician will be a primary resource on the patient’s medical condition and needs. The hospice nurse will be in regular contact regarding symptom management, changes in the patient’s condition, and need for clinic or home visit follow-up.
The physician is resonsible for:
- signing the initial certification of terminal illness
- reviewing the hospice plan of care for the patient
- ongoing clinic visits with the patient
- prescribing medication for comfort care
- reviewing with hospice staff the patient’s condition and prognosis
- making telephone contact and house calls to the patient as necessary
- signing the death certificate
- home visits when necessary
Extending Care Through the Hospice Team
Because the care needs of a dying patient encompass more than medical treatment of a disease, the hospice team can be a valuable resource in dealing with complex issues and extending the physician’s care.
“Most physicians would say hospice care is worth the investment,” said Michael Levy, M.D., Ph.D., director of the supportive oncology program at the Fox Chase Cancer Center in Philadelphia. “[In many cases] the doctor doesn’t get calls [or] go to the ER in the middle of the night because hospice takes the calls and the hospice nurse goes out to the home.”
“The hospice team is skilled at patient and family education,” Dr. Levy continues, “so medicines are taken properly and side effects can be anticipated and treated.”
The team approach to hospice care can ultimately alleviate much of the stress traditionally associated with care of the dying patients. According to Ira Byock, M.D., Hospice Medical Director and Chair of the Ethics Committee of the Academy of Hospice Physicians, “Care of the dying stops being a stressor and starts being a source of professional satisfaction” (Skelly, 1994).
Hospice Interdisciplinary Team
Attending Physician Patients designate an attending physician to manage their care.
Hospice Medical Director The Medical Director oversees the treatment by the hospice team and coordinates with the Attending Physician.
Hospice Nurse Hospice Nurses coordinate the individualized care plan and provide specialized palliative care services.
Social Worker Hospice Social Workers offer emotional support, counseling and community resource support services.
Spiritual Care The Hospice Spiritual Care Coordinator assists in identifying spiritual concerns and the connection with a community of faith.
Home Health Aide Hospice Home Health Aides assist with personal care and light housekeeping services.
Other Therapists Physical, occupational and speech therapists provide palliative care according to the individualized care plan.
Bereavement Coordinator Hospice Home Health Bereavement Care supports the person and family throughout the dying process and offers follow-up grief education and support .
Volunteer Trained Volunteers provide a variety of services, including companionship and respite care.