Tuesday, November 25, 2008

Healing Skills for Medical Practice, Part 2

This post is the follow-up to Part1 posted on Sunday. The first four healing skills for medical practice were reviewed previously. In that post, the skills were discussed in respect to their innate practice of good hospice & palliative medicine. Here are all eight for a quick review:

  1. Do The Little Things
  2. Take Time and Listen
  3. Be Open
  4. Find Something to Like, to Love
  5. Remove Barriers
  6. Let the Patient Explain
  7. Share Authority
  8. Be Committed and Trustworthy
Remove Barriers
I completely agree with the physical barriers that communicate power and authority, such as standing over a patient to examine them. I feel most comfortable and the least invasive in my physical exam when I am able to sit down next to a patient (not on their bed, next to it). In this way I can ask questions at the same eye level, and reach across the patient instead of reaching down to them when performing the physical exam.

Try this experiential test on yourself. Sit in a chair in a somewhat reclining position. Ask a staff member, family member or friend to lean over you as if they were to examine you. You will quickly see it does not feel very safe nor comfortable to be in the 'patient' position. What other barriers do you see removed as part of everyday palliative care?

Let the Patient Explain
This expounds upon the earlier take time and listen, and in the article the authors do not really explain well the difference between the two. Maybe eight was a better number for a list, instead of seven? See previous post.

Share Authority
This goes for both the patient-physician relationship and the physician-staff relationship. The article focuses on the patient-physician aspect which palliative care reinforces with goal-directed discussions and treating the whole patient, and the concept of total pain.

In sharing authority with staff, the palliative care physician hold a unique spot in medicine. Palliative care is built on the foundation of a mutual respect for the expertise of all disciplines which is reinforced by a horizontal leadership structure, rather than the classic vertical medical hierarchy with the physician on the top. It feels natural for most palliative care docs to call upon the various disciplines for their input, expertise and direction when implementing a plan for a patient-family unit.

Be Committed and Trustworthy
Initiating end of life discussions within five minutes of meeting a patient demands a rapid building of trust. This isn't something palliative docs or nurses do every day, but it happens often enough and you never know if that is where you may be going when you first meet a patient or family, so one needs to do all of the above things to demonstrate trustworthiness.

This is a great quick teaching article full of quotes from the interviews that should prompt discussions with learners and staff. Please add any of your own healing skills in the comments.

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