Tuesday, December 2, 2008

Proud of Staff in Dealing with Dying Patients

On Thanksgiving, Dr. Bob Wachter, Associate Chairman of Medicine at UCSF wrote a excellent post on his blog Wachter's World, praising the palliative care service. It has a wonderful double-take title: "My patient's are dying...And I've never been prouder."

I don't need to make any comments except to say, "Thank you to Dr. Wachter for writing a excellent overview of why palliative care is so integral to good medical care."

Some key excerpts (but please, please read the post, and comment to thank him (reg req'd):

But in the hospital world, these twin trends – hospice on the one hand, and decision-making regarding CPR and mechanical ventilation on the other – remained strangely dissociated. The movement promoting compassionate care for dying patients was largely community-based and tended to focus on patients dying slow and painful deaths – mostly those with terminal cancer. Meanwhile, in the hospital we were exploring the senselessness of “doing everything” for (or, more to the point, to) patients with poor prognoses, troubled by seeing lives end so violently, stripped of all dignity. But we spent virtually no time thinking about how to bring hospice-like sensibilities and resources into the hospital. Frankly, as I think back, many of us saw that work as being a bit too touchy-feely for our tastes. We were doctors, after all, not social workers.
...
But the larger tragedy of our failure to embrace palliative care as a legitimate discipline was that by continuing to view death as a failure, we failed to gain the expertise and garner the resources to promote affirmative conversations with patients about alternatives to aggressive care.
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Whenever I call the PCS to help care for one of my patients – as I’ve done several times this month – I am always awed by my colleagues’ skill and compassion, and the practical help they, the PCS-trained nurses, and PCS social worker Jane Hawgood, bring to bear at times of great need. And every time they are involved in a case, my medical students and residents, and the ones rotating on the PCS (which – as one small measure of the transformation – has become one of the most popular electives at UCSF) broaden their definition as to what it means to be a great doctor.
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At one point or another in virtually every case, family members hugged me, members of my team, or members of the PCS and thanked us for our wonderful care – this at the most horrible time in their lives. It is uniquely sobering and gratifying.
This last point is the reason that I became aware of palliative care and looked into it as a field. Thanks again Dr. Wachter.
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