I Wish We Had Hospice Sooner

Posted on

Nov 06, 2015

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One reoccurring comment hospices receive is, I wish we would have received hospice sooner. So, why are families not informed about hospice earlier? It is a complicated question, but one reason lies with doctors.

Doctors are often the gatekeepers to hospice referrals because Medicare requires a doctor to certify that the patient could pass away in the next six months if the illness runs its normal course. As a result, some doctors are reluctant to refer to hospice.

Interestingly, doctors often state they believe hospice helps improve the quality of life for those with a serious illness. So why are doctors hesitant to refer to hospice? There has been a recent study suggesting that doctors do not want to accept the fact that their patient will die. It also indicates that doctors have been socialized that death is a failure.

Reasons doctors may struggle to make a hospice referral:

Lets face it - doctors are humans and talking about the possible death of their patient can be very uncomfortable. It may be more comfortable ordering a procedure than to have a difficult heart to heart discussion.
Determining the right time to have the conversation about end of life wishes can be challenging.


Doctors may believe their job is to cure or to relieve a particular symptom. Some may think that referring to hospice could cause the patient to lose hope or give up.
Doctors may believe some of the frequent misconceptions about hospice. A common myth isthat the doctor will have to give up their patient and hospice will withhold services from their patient. However, most hospice companies want the doctor to remain involved.
Patients often see multiple physicians. Doctors may believe that the disease they are treating is not the life-limiting illness so they are waiting for another physician to have the conversation.
Time doctors treat patients in a system that discourages lengthy visits. These conversations take time.

The Good News:

The Care Planning Act has been introduced into legislation. If approved, this will create a new Medicare benefit called Planning Services for those with advanced illnesses. This approach will give individuals facing serious illnesses more of a voice in their care. Additionally, this bill would allow doctors to be reimbursed for time spent with their patients having these conversations.

In the meantime remember your doctor is human. If you have questions about any end of life issues dont hesitate to begin the conversation with your physician if your physician does not initiate the conversation.

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