Sunday, April 4, 2010

Best of March 2010 Comments

Pallimed had a great month of comments and a busy month of posting with 21 posts overall (average between 14-20 lately). We also welcomed two new bloggers, Brian McMichael and Suzana Makowski. Thanks for all your comments and keep them coming. Comments are so vital to blogging, so feel free to add your voice.

March 2010 posts with the most comments:

  1. Implantable Cardiac Defibrillators- Hospice Role in Deactivation? - 15 comments
  2. Emergency Room Visits by Patients with Cancer Near End of Life - 7 comments
  3. Palliative Care: (Un?)-Necessary Specialty - 7 comments
  4. Medicare Beneficiaries and Three Year Mortality After ICU Stay - 5 comments
  5. Several posts with 4 comments

March 2010 Posts with most visits:
  1. Implantable Cardiac Defibrillators- Hospice Role in Deactivation?
  2. Cancer Reporting in the Media - Guess what they report on?
  3. Emergency Room Visits by Patients with Cancer Near End of Life
  4. Symptoms, Suffering, Parents and Pediatric Palliative Care in End-Stage Cancer, Part 1
  5. Three Excellent Blog Posts For our Field

I read EVERY comment and while all of them are appreciated there are always a few that stand out and deserve more attention. You should probably read all the comments on Implantable Cardiac Defibrillators- Hospice Role in Deactivation?. So now to our 'Featured Comments':

Tammy Quest from Emergency Room Visits by Patients with Cancer Near End of Life:
The emergency department is often left to negotiate the last "time limited trial" - antibiotics, fluids, non-invasive ventilation - when the system has not responded or not responded to satisfaction of not prompting an ED visit. We do our best, with little information, often in the night, with an often non-decisional patient with no advance care plan. It can be lonely and difficult. The on-call doesn't know the patient, you don't have the information and the goals of care are blurred by intercurrent physical, spiritual or psychological unrest. The on-call hospice nurse doesn't know the patient or didn't know they called 911.

Clay Anderson MD from Palliative Care: (Un?)-Necessary Specialty:
dinosaur #1's commentary is partly about what palliative care and palliative medicine is, vis a vis the debate about language moved along by meier's and morrison's comments at AAHPM which i have reflected on at the AAHPM blog and gerimed, and also about wishful thinking. about language: in reality, however we in PC want to define or redefine or move upstream our field, mainly what we do and what we will do is take care of dying people, and that is what we love to do. yes we are good with symptom management and goals of care discussions but how we GOT good at that and stay good at that is taking care of dying people. as we move upstream, which we should, we can modify our practices and our language, but our defining core should not change. most primary care docs and specialty care docs don't do much of this and don't like it that much either. that is the wishful thinking part. lots of data show that, whether a FP or a med onc like me, most may say the know PC, can do PC, can do PC well, and do PC now....... but they don't do it!!!! that is why we are and will be needed. they don't do it and aren't planning on doing it any time soon, and patients and citizens and hospitals are demanding it, so here we are, in our nascent "specialty" (calling?), doing it, because it is what we want and need and love to do. so go for it, dinosaur #1, but show us how much of it you do and how soon in your practice, and don't expect many your colleagues to follow your example any time soon.

Barry from Cancer Reporting in the Media - Guess what they report on?:
For the most part, the general public is more often than not ill-informed on these critical issues. The media has consistently demonstrated a lack of understanding or ability to articulate clearly on these and other end of life issues. The public is not well served in coming to terms with dying and death or coming to grips with the complexity of end of life decision making. The media, for the most part, "ain't helping the situation." In an age that insists on brevity in the spoken or written word, there are few opportunities for in-depth reporting. The primary objective of the media, it seems, is to provoke, not necessarily to inform. [The Internet cannot be ignored. It's perhaps sufficient to point out that the Internet is embraced as an inexhaustible source of information ...but, information is not synonymous with knowledge.]
In palliative care there is oft heard the call to "educate" the public. The real need is to educate the "sources" of information that influence a person's decision making. For the one-on-one situation, it's the health professional who is best situated to facilitate discussion. In terms of the public-at-large, however, it remains the media – a double edged sword if ever there was one.

Joanne Kenen from Three excellent blog posts for our field:
Just wanted to add a thought about the other two posts you linked to about the politics of the "death panels" and how it affects the language you use about death and dying. Remember that the "death panel" brouhaha was part of an organized political effort to derail health reform. It started with right-wing commentators a few weeks before Palin's Facebook comment -- which was pithy and powerful but Palin wasn't where or when that all began. Your blog linked, in fact, when we wrote about this in July, before the Palin comment and the start of the town meetings. It was about the emergence of end of life "rationing" as a vehicle for attacking reform. So yes, it touched all sorts of chords and fears deeply ingrained in our culture and our medical system about death. But it also was designed to serve a political purpose and to tie into fears and beliefs not just about death but about the size, role, and power of government. And about who, right now, has the power to govern.

Brian McMichael from Origins: Physical medicine and Rehabilitation to Palliative Medicine:
We volitionally climb into that tight space which our patients have come to occupy. Often suffering the glaring impotence of our attempts at intervention. Yet we abide with them sometimes only tinkering at the margins of pain and suffering and loss. So, to me it is a strange and arbitrary decision not to continue the care of our patients into the end of their lives; these patients and their families whom we have come to know so well. To me it is better and simply more fitting to our type and style of patient care to add some related skills to our repetoire and extend our abiding just a little further.

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