Friday, March 1, 2013

When Your Family Physician Retires...

I went to my family doctor for my biannual physical a few weeks ago and was surprised and just a little shaken to learn that he will be retiring from the practice component of his work this coming September. I had been expecting to hear this news sooner or later but the reality felt worse than the anticipation.

I felt a little as though I was a four-legged stool that had had one leg kicked out. I have known our physician since he was an intern at the teaching hospital in which I worked in the 70's and, over the years of my husband's life with and death from cardiomyopathy, we spoke by phone several times a week and he visited us at home for the three years that Derrick was confined to bed. Over tea and cookies after he'd examined his patient, we came to know him better and liked him all the more. He visited us in hospital during the last week of Derrick's life and both called to check on me after Derrick's death and attended his funeral. He has walked an intense portion of life's journey with us and I will miss him and his kind, steady, support.

I don't think that people generally reflect deeply upon the importance of their relationships with family physicians until they or someone they love is really ill or until those physicians are leaving or have already left. We certainly don't do that as a society, a fact demonstrated by the absence of research into the emotional impact of physician retirement on seriously and/or chronically ill patients and their care partners. And yet, that impact can be great, even destabilizing in some cases.

As with any attachment, particularly a dependent one, the breaking of the physician-patient-family care partner relationship is a loss that evokes grief. In the case of patients and care partners already experiencing chronic sorrow and reduced social support, that grief can feel overwhelming. Even relatively short physician absences can evoke sadness, anger, anxiety and distress.

I remember when our physician played a game of hockey and badly injured his neck, requiring surgery and time off work for most of the last six months of Derrick's life. It was an enormous loss and source of concern for us - worry for our physician, himself; fear about loss of continuity of care and of all the facts rattling around in his head that I might or might not be able to remember on a given day; loss of his relatively easy availability, based on his belief that home palliative care was impossible without physician accessibility and home visits; and his willingness to entertain "outside the box" solutions for Derrick's longterm pain. His absence brought into sharp relief all the qualities with which he'd graced our lives over the years.

I think it is important that we make space to grieve the loss of such a significant relationship whenever a physician retires, is absent for a long period, or when a patient dies and the degree of contact with the care partner changes - space for the grief of physician, patient, and family care partner alike.

It matters that we give each other time to acknowledge the alteration in the previous pattern of life, to say goodbye, and to express unfinished business, concerns and gratitude - aside from all the administrative details. We need a chance to say what the relationship has meant to us. At it's best, the physician-patient-family care partner relationship is one of mutual care, compassion, learning and partnership - and, thus, one deserving of its grief.

So, as it draws to a close, I would like to take the opportunity to publicly acknowledge and thank Dale Stogryn, a fine man, a fine physician and an excellent medical educator, for a twenty-five year relationship of care, respect, compassion and great medicine. I am glad that you will continue with your work in medical education but those of us in your practice will be the poorer for your absence.

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