End-of-life care for the hospitalized patient.

The majority of Americans die in hospitals where shortcomings in end-of-life care are endemic. Patients often die alone, in pain, their wishes unheeded by physicians. Hospitalists can improve end-of-life care in hospitals dramatically. Hospitalists must relieve symptoms, such as pain, dyspnea, nausea, vomiting, delirium, and depression; communicate clearly; and provide support to patients and families. Hospitalists can increase the number and the timeliness of hospice referrals, allowing more patients to die at home. Finally, physicians must attend to their own sense of grief and loss to avoid burnout and to continue to reap the rewards end-of-life care provides.