We're Not Surrogates

I know hospice is misunderstood. I encounter this misunderstanding routinely. Hospice is misunderstood because dying is misunderstood. If people understood that dying began at birth, their perspective would shift. They'd want to ensure planning for the best at the end.



Hospice is its own entity. It is not an extension of the medicine which ran prior. A hospice physician, while trained in "classic" endeavors like internal medicine, family medicine, or emergency medicine for example, is a niche sub-specialist. The physician, while taking on the oversight of other subspecialties like cardiology, gastroenterology, or nephrology for example, manages their domains from the realistic standpoint of the declining patient. A hospice physician, in the ideal, should be a boarded expert in the recognition and management of this decline and of active dying. Hospice physicians recognize decline, recognize what is reversible and irreversible about that decline, estimate a spot-on prognosis, and manage all aspects of active dying or transitioning.

This is where there is confusion. When you are choosing a hospice, you should choose it as you would a good cardiologist for your heart, or a good dermatologist for your skin. You should be choosing a good hospice with a good palliative care physician and good palliative care team. This team will be your specialty team managing your case through your decline, until you finally pass. As morbid as it may initially sound, this team is the team of experts in dying. They are not surrogates for other specialties. They are their own.

Every other specialty in medicine deals with living. Hospice and Palliative Medicine, borne out of the acceptance of our mortality, and the desire to manage this process optimally - because management of dying makes a difference in how one dies, - deals with death. It is an incredible specialty, one which is misunderstood by many, even most of our own in medicine. This is why it is essential to clear up the idea that hospice is an amorphous extension of what was already being done. It is not. Everyone dies, and dying is its own incredible entity. Wouldn't you want an expert to manage that process?

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