Sunday, March 13, 2011

Susan Block talks Suffering, Grief, and Peace in the Harvard Business Review

I know, you are probably saying, what, huh? Harvard Business Review you may be thinking to yourself... isn't that for articles about how to best secure venture capital funding and what to do when your lead computer programmer decided to take his intellectual capital to your business rival?  Well sure there are business heavy articles in HBR, but they do highlight innovations across different businesses and frankly I have found numerous articles there that would be relevant in medicine, particularly articles featuring customer service challenges and employee feedback.  Dr. Block's article writes on how to change the medicine culture and approach to illness and death which may improve health care outcomes with aligned goals.

A choice quote:
Others write about the uncertainty over whether and when someone will die (it's real), the way financial incentives drive overtreatment (they do), and the lack of coordination of care for complex, seriously ill patients (absolutely true). What intrigues me is how our fundamental humanity undermines our ability to do our best for our patients.
In the article Block talks about what areas would need to change to make our health care system more effective at meeting achievable health care goals. I am glad she pointed out the role for the public media, because I think they are important to getting stable clear messages through the political din of 'death panels' and the like. But I also think that the role of the health care professionals in public health education needs to be addressed far before we get to the one-on-one family conference that is so resource heavy. We are a smart bunch of people, right?

 So let's get our message out there in multiple ways that are not dependent on the whims of the public media to pick the sound bite we think is most important. Eric Widera is doing a great job of this by getting involved with blogging at GeriPal and using Twitter much more effectively and he is getting interviewed by the New York Times and LA Times. This potential is there for all of us. We have the means to publish with only the investment of our time.

Another point I thought was intriguing in this article was her bullet point on checklists and scripts. Obviously a nod to Atul Gawande and his pioneering efforts in telling the narrative of research effectiveness. But what would a checklist for palliative care look like. Do any of you use them now? Will it work to treat the patient correctly with the best evidence but also retain the humanity and relationship that is so important to build trust in our work?

A quick Google search for 'checklist in palliative' found a couple examples.
Rotterdam Symptom Checklist (1999)
At-home palliative sedation for end-of-life cancer patients (2010)
Fast Fact: Palliative Care and ICU Care: Daily ICU Care Plan Checklist

Other things menitoned in this article will probably not be too ground breaking to anyone who does this daily, but to get this message to people outside our field is fantastic. So go comment (as I have - wouldn't ask you to do something in social media, I would not do myself) and show the passion of this community.

Found via multiple tips from Twitter

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