Last month I closed my practice in the big city because my husband and I bought a house on an island. It was a challenging three-month transition process, yet I had some valuable insights about how doctors can say goodbye to their patients.
More than one goodbye.
Patients benefit from a multi-stage departure – it lets them get used to the idea. Once I knew my last day of work, I started letting patients know right away. It was important that they have time to let the idea sink in. I scheduled a final appointment with each patient to make sure that prescriptions and investigations were up-to-date. We also co-created a handover note for the incoming physician that included on-going issues and and agenda of concerns.
Goodbyes are therapeutic.
I recall a professor from grad school giving a lecture about the importance of practising the end of relationships. We tend to avoid the permanence of goodbye, preferring a “see you later” or “until next time” when we know that’s unlikely. It’s healthy to acknowledge the end of a relationship, particularly a trusted one like we have with our patients. I also used these final appointments to affirm their achievements during the time we worked together with motivational interviewing.
The temptation to not say anything.
Saying goodbye is tough and at times I’ll admit I felt tempted at times to not inform certain patients because I knew that the emotional weight might be heavy. Yet, avoidance risks harming the doctor-patient relationship, both with myself and future physicians. Many of our complex inner-city patients already have significant healthcare-related trauma and tenuous trust in our white coats. There’s no need for me to confirm those feelings of mistrust.
Expect a reaction.
As I reviewed my schedule each day I considered how each patient might react. This emotional labour was well worth it even if, on occasion, I was wrong about how a patient would react. One patient who lives with significant mental illness had grown quite attached to me, so I made sure we had enough time should they get tearful. Instead, they wished me “good luck” and gave me a fist bump on their way out the door. With the door closed, I laughed aloud – at my misjudgement and happy because this demonstrated they were doing better.
Some may criticize this approach due to its emotional labor. In their book Compassionomics, Mazzarelli & Trzeciak (2019) challenge the idea that practicing with compassion is an energetic drain. Rather, it can refuel us when the work aligns with the reason we became doctors in the first place: to help people. That’s how I try to practice every day.
Our last appointment together.
What did I actually do? As usual, I set an agenda, and ensured there was time at the end of the appointment for the farewell. I asked questions like:
- What are some goals you have as you get started with a new doctor?
- What are some things that you would like them to know as you begin working together?
- What are some things you worry about as you transition to a new provider?
Finally (my script).
To most of my patients I said a variation on the following:
“Thank you for trusting me with your health care. It’s been an honour to know you. I wish you all the best.”
Ultimately, the refrain I heard most was a variation on “Sad for me, happy for you.” A few of my patients struggled with the idea of a new doctor and some, I’m sure, were happy to see the clinic door smack me in the backside. Regardless, with this framework I felt I reached closure and said goodbye to my patients in a good way.
Marcus Greatheart MD MSW is a family physician and social worker on Vancouver Island, BC. His latest publication Be the Doctor You Always Wanted to Be: A Workbook for Inspiring Physicians will be published in summer 2022 by Ethica Press.