title: "When patients and families feel abandoned".
abstract: OBJECTIVE
  Patients with serious illness derive a sense of security by forming strong, healing relationships with their providers. These bonds are particularly strong in life-threatening illnesses, such as cancer, which carry the stigma of death and suffering. These strong relationships create expectations in patients that are not necessarily shared by their clinicians. Providers often focus on treating disease and emphasize technically excellent, "evidence-based" practice while failing to fully appreciate the power of the patient-provider relationship. In contrast, vulnerable patients expect much more than technical competence, including open and clear communication, security, continuity, and access. Patients are often left feeling abandoned when their providers do not meet their expectations, even when their care is technically sound.
  
  
  RESULTS
  In this paper, we describe scenarios that can lead to feelings of abandonment and discuss strategies to avoid and respond to them.
  
  
  CONCLUSIONS
  These strategies can help us maintain healing relationships with our patients by maintaining their trust, confidence, and satisfaction. Cultivating relational aspects of medical practice requires an interchange and takes time. Experienced doctors know this and continue to do so because being present and staying with the patient during difficult times is a pillar of moral and ethical training and a fundamental attribute of a good physician.
authors.affiliation: Department of General Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA. depner@mdanderson.org
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Epner
authors.forename: Vinod
authors.initials: V
authors.lastname: Ravi
authors.forename: Walter F
authors.initials: WF
authors.lastname: Baile
mesh_terms: D003142:Communication; D003266:Continuity of Patient Care; D005190:Family / Q000523:psychology*; D006297:Health Services Accessibility; D006801:Humans; D009369:Neoplasms / Q000523:psychology*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D016079:Refusal to Treat; D035502:Trust