Family Doctors Are a Consistent Presence in Challenging Times

Doctors’ Notes

Real stories by real family physicians

Working as a palliative care doctor has shown me how important a trusted family doctor is when patients face a serious or terminal medical condition.

by Dr. Christine Khandelwal

About the Author
Dr. Christine Khandelwal
Christine Khandelwal, DO, is a trained family doctor who subspecializes in hospice and palliative medicine. She is Director of Inpatient Palliative Medicine at Transitions LifeCare, a palliative care consulting service in an urban, community-based hospital system. She is also an active adjunct faculty member at the University of North Carolina School of Medicine, Chapel Hill. In these roles, Dr. Khandelwal has the opportunity to teach medical students and second-year family medicine residents how to communicate difficult news, how to understand and discuss a patient’s prognosis, and how to manage symptoms caused by end-stage diseases.
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I sat trembling, clasping my patient’s frail hand as I held back tears. Patricia (not her real name) told me about being diagnosed with terminal cancer and described her current symptoms. She was afraid her ability to function would continue to decline. Patricia also told me about her grandchildren and the joy of baking cookies with them. She talked about playing cards with her two best friends. Knowing she was near the end of her life, she confided in me how much she would miss these special moments. Her honesty and insight deeply moved me.

I was at Patricia’s bedside because I’m a palliative care doctor. Palliative care helps people who have a serious medical condition have the best quality of life they can. They may have cancer that is not curable, as in Patricia’s case. Or they may have another chronic (ongoing) or life-threatening medical condition. (Learn more about palliative care.)

Patients who have a serious or terminal medical condition can talk to their family doctor about how it affects their quality of life. For example, they may have adverse effects from their treatment or chronic pain. In some cases, a patient’s family doctor will refer the patient to a palliative care doctor like me. As part of the health care team, I specialize in improving patients’ quality of life. I help manage their pain, relieve their symptoms, and ease their mental and emotional burdens. I also support their families and caregivers.

Until six years ago, I worked as a full-time family doctor. Then, I decided to specialize in palliative care. Using my training and experience as a family doctor, I wanted to focus on guiding patients and their families through every step of dealing with a serious or terminal medical condition.

The day I sat with Patricia, I talked with her about her concerns. I shared information about ways to improve her quality of life. She thanked me for coming by. Then, she said, “I need to talk to my family doctor. I cannot have these difficult discussions and make these hard decisions without first speaking to my family doctor.” I understood why Patricia felt this way. Working as a palliative care doctor has shown me how important family doctors are as a consistent presence in their patients’ lives. This is especially true when patients and their families are dealing with complicated medical conditions.

When I was a full-time family doctor, I cared for many patients who had serious illnesses. I often had difficult conversations with my patients and their caregivers about their prognosis and their goals for future care. A trusting doctor-patient relationship is key when you need to have these difficult conversations. That’s one reason family doctors play an important role in palliative care.

As Patricia’s cancer progressed, she trusted her long-time family doctor to coordinate her care. One of Patricia’s main goals was to remain in her own home for the rest of her life. With ongoing support from her caregivers, her family doctor, and the rest of her care team, she was able to accomplish this goal.

Quick Tip

Palliative care can begin any time after a patient is diagnosed with a serious medical condition. It continues during treatment. You may have also heard of hospice care. Hospice care is a form of palliative care that is typically for people who have 6 months or less to live. It begins when treatment has stopped. Hospice care offers spiritual, mental, emotional, and physical comfort to patients, their families, and their caregivers. Patients receiving hospice care are made as comfortable as possible through the end of their life.