On Saying Goodbye: Acknowledging the End of the Patient–Physician Relationship with Patients Who Are Near Death

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” is not quite true; he doesn't actually think he will ever see her again. Dr. B. intends to be casual and cheerful, but he is missing an opportunity to acknowledge with Ms. White that their relationship is ending.

In this paper, we offer guidelines for physicians about how to say goodbye to a patient who is in the last phase of life. While other physicians have described how to talk about dying (1, 2) and what to do after a patient dies, such as write a condolence letter (3), go to the funeral (4), or grieve privately (4, 5), we know of no medical literature that describes how a physician can say goodbye to a patient who will probably never make another visit to the clinic or hospital. We think that saying goodbye is an expert practice worth learning for the sake of both the patient and the physician.