'How the fuck am I supposed to know?': Good Practice and Bad Results in the Care of the Dying

Clinicians in Hospice and Palliative Medicine (HPM) specialize in the care of the terminally ill, whose treatment is often considered a failure of medical intervention. The practice of HPM is distinct from their colleagues in other areas because of this unique patient population and the interventions they use. Considering that they are commonly treating patients who are likely to be considered failures of medical intervention by their colleagues, how do these clinicians understand how they have done a good job? In this paper, I explore the unique strategies used by clinicians in HPM to promote success and avoid failure. Rather than longevity or cure, HPM clinicians define good practice as the coordination of all clinical stakeholders (patients, family and colleagues) to a shared goal which they construct from the achievable medical outcomes and the stated preferences of patients.