Teaching doctors a new approach to the end-of-life process

CanadaSue · 07-16-2012, 11:53 PM

http://www.theglobeandmail.com/life/...rticle4416607/

Great idea - this has got to be one of the most difficult aspects of care for doctors & some role playing sessions along with a discussion of important factors may provevery helpful for everyone.

dharma · 07-17-2012, 12:13 AM

Great idea, indeed. Those conversations are hard. I dealt with a lot of minority patients, and there is a big cultural factor that was very tough at times—they were very sensitive to any indication that their relatives weren't receiving the very best medical care, which made difficult interactions even more arduous.

Toughest part is going to be getting faculty for these courses, I'd imagine.

CanadaSue · 07-17-2012, 12:25 AM

What concerns me is that a lot of people in the health care fields might find this defeatist - as though they're tacitly admitting they're 'giving up' on a patient. I think it's more a case of keeping the patient's best interests in mind. Why agressively treat an illness only to buy a few weeks of discomfort. To ME, it makes more sense, if it works with the patient's personal views, to allow them comfort & relief of symptoms. I'll admit death scares me - it's the Great Unknown. A bad death really scares me. I see no virtue in needless suffering. We can't choose what will kill us or eliminate pain & suffering entirely but making it clear to patients and/or their families that that may be a good option is good. Doing it appropriately, empathically? Tough stuff & I didn't even think too much about different cultural aspects.

Yeah, who's qualified to teach such a course? I think you'd need a few different specialities involved.

Mousehound · 07-17-2012, 12:33 AM

I am seeing Palliative care being actively practiced with my dying patients. Doctors are supporting this as much as they can. It becomes difficult when family members want to max. out the health care possibilities, but most families understand that excess pain should be prevented when things have progressed too far for a recovery.

Feather · 07-17-2012, 07:41 AM

When Mom's dr came in to talk to me and Mom about how Mom was doing, the first thing Mom said was can you get me a DNR to sign? We had talked about it and I told her it was her decision and I would go with what ever she wanted. I had see the change in the collection bag on her cathetor, her urine had gone from straw to brown and I knew it meant her kidneys were shutting down. The one that had a problem with it was her sister, she told me to my face that I was trying to kill my Mom for some reason. She even offered to give Mom one of her kidneys.

Mama Alanna · 07-17-2012, 11:19 AM

Quote:

Originally Posted by CanadaSue

What concerns me is that a lot of people in the health care fields might find this defeatist - as though they're tacitly admitting they're 'giving up' on a patient. I think it's more a case of keeping the patient's best interests in mind. Why agressively treat an illness only to buy a few weeks of discomfort. To ME, it makes more sense, if it works with the patient's personal views, to allow them comfort & relief of symptoms. I'll admit death scares me - it's the Great Unknown. A bad death really scares me. I see no virtue in needless suffering. We can't choose what will kill us or eliminate pain & suffering entirely but making it clear to patients and/or their families that that may be a good option is good. Doing it appropriately, empathically? Tough stuff & I didn't even think too much about different cultural aspects.

We had to fight the doctors to let my grandmother die. She was 95, and was eating and drinking almost nothing. She had blood clots in her heart, and they were breaking off and causing significant problems, like TIAs. Eventually she threw a massive blood clot into one of the main arteries of her leg. It was getting no blood flow at all, just as white as a sheet and she could no longer feel it. Shortly after she became delirious, arguing with people who weren't there and complaining that there was a wasp nest in the corner of her room.

The doctors wanted to amputate her leg at the hip and put her into intensive physical therapy. Since Mom had durable medical POA, she could and did say no, but it took backup from both Sister and me. They were really pressuring Mom, and we kept saying "95. Wants to die. COMFORT CARE ONLY." I suspect that surgery itself would have killed her, because she was just that frail.

rb. · 07-17-2012, 01:17 PM

Doctors here will operate on the elderly, if they are relatively fit. I can't imagine a doc in Canada pushing to amputate a limb in that situation. Suggesting it as a possibility, yes, pushing, no. Mom's palliative dr. was wonderful. Her oncologists offered all available treatments, but didn't push as her situation was pretty hopeless.

lilly · 07-17-2012, 03:08 PM

Two sisters who go on the jitney for physical therapy three times a week are in their nineties. They are practically bent over double from the collapse of their spines. Their spines are shot.

I assume they are getting moist heat, but what kind of therapy? I don't know their mental state, but they move like molasses in January. Living their lives out in their own homes. Very slow witted and even slower moving, but pleasant women. One of their husbands used the adult day care for years to give her a respite. He now is in a full care facility.

One of the reasons I'm moving, walking and concerned enough to do something for myself. I want quality of life, not simply existing.

sandyd · 07-17-2012, 03:10 PM

Maybe a good way to deal with all the cultural issues is to ask people who didn't choose comfort first and then later say "I wish I had not done _______ procedure" to talk about it on short videos.

I had a mexican guy, 80, diabetic, who had a MI and didn't want open heart surgery but his family talked him into it. A year later and he was still in a nursing home never having healed...his freaking chest incision still wasn't healed and the bone never did and he came back to the hospital with infections a few times. I saw him the last time and recognised him and where he finally talked his family into letting him go with hospice.

His family told me they felt awful cuz they made him suffer so long, not willing to let him go.

A few good videos like that with different cultures would help a lot!!

Might even be good to have families see other families talking about it so they know others have gone before them down the same paths.