Posts tagged patient care

Bohemian Polypharmacy sung by Aivia, concept by Dr. James McCormack.

James McCormack is a doctor of pharmacy who is well known in Canada for his work in the Therapeutics Initiative, an independent party separate from the government and the pharmaceutical industry aiming to provide evidence-based information on drug therapy.

He is perhaps lesser known for his other side projects, one of which includes making parody music videos surrounding the world of medicine and medications.

In this video, he tackles the topic of polypharmacy.

Being a doctor was once a job with great purpose. Now it's just a business

The ‘free market’ approach to healthcare means seeing more patients in less time. We’ve lost the human connection in health reform.

This is a call to begin a spirited discussion centering on such real healthcare reform. I am not naive to the hard economic realities of healthcare delivery or how civil discussions on reforming healthcare payments need to continue. However, meaningful and lasting solutions will not be found in models that commoditize health and continue to be based on a foundation of reward and punishment alone. They will be found in models that bring back the joy of healthcare to professionals who deliver it – physicians such as me and countless others who seem to have lost the single most powerful driving force – purpose.

A disease is a whole, because one can assign it its elements; it has an aim, because one can calculate its results; it is therefore a whole placed between the limits of invasion and termination.
Audibert-Caille, 1814.
Hospice Care.

A reader asked me what hospice means. To understand hospice, I need to discuss its purpose.

Hospice care is very specific to a terminal patient. It involves palliative or ‘comfort care’ for life-limiting illness rather than curative treatments. It involves professional medical care, advanced pain and symptom management, and emotional, spiritual and practical support based on the patient’s wishes and family’s needs. In Canada, the terms ‘palliative care’ and ‘hospice care’ are often used interchangeably. The word ‘hospice’ is sometimes used to refer to a home-like place where people spend the last days or weeks of life.

I am sick of the pink. This is not pink. Pink is not breast cancer. Look at me. This is what breast cancer is.
A patient’s experience of feeling trivialized.
This has been a patient safety announcement.

This has been a patient safety announcement.

Fixed!
Sometimes in the midst of all of the problems we are treating, we can lose sight of what the goal is: treat the patient and not the number. This cartoon pokes fun at this idea and quiet appropriately so. Behind every test and every lab value is a person.

Fixed!

Sometimes in the midst of all of the problems we are treating, we can lose sight of what the goal is: treat the patient and not the number. This cartoon pokes fun at this idea and quiet appropriately so. Behind every test and every lab value is a person.

The Burning Flush of Confrontation

I stood there and did my best to explain what we felt was going on, our impression of the possible causes, and our investigations around them, some of which simply could not be done tonight.

The family was not satisfied. “We want answers. Now.” From there came the questions. “Why must it happen later? Why is this test being done? Why will you not take our complaints seriously?”

I reassured everyone that we were checking every avenue, that there was a method and reason behind the tests and explained as plainly and thoroughly as I could. More importantly, I tried to address their concerns up front and with honesty.

Nothing could appease my audience. I could feel the growing dissatisfaction in their tone, the tension that my presence brought to an obviously well meaning and concerned family.

However, standing there, the focus of every pair of eyes in the room, I began to feel the churning of my stomach, the pounding nudge in my chest, and the burning flush of my face. I had become an enemy in the room, an obstacle between the vocal family who wished to be heard and heard by none other but the doctor himself. It was time I excused myself.

I returned quickly to my attending and explained the situation: I had attempted my best to alleviate their anxiety and answer their questions but I had failed. I needed help.

When he arrived, even then the discussion presented challenges. It took a lot of work to come to an agreement and understanding.

The communication channel is open both ways. The solution to defusing a situation like this is always to make people feel that they have been acknowledged, that their concerns have been understood, that they are not an afterthought in this already complicated system of care. Even with that in mind, the discussion can be challenging. It really takes a lot of patience, perseverance, and thick skin to build up the rapport needed in difficult situations.

Perhaps with time and experience, I can find a way to finally manage this myself. For now: please do not shoot the messenger.

Were you ever involved in a confrontation? How did you deal with it?

Exam Tomorrow.
Psychiatry has been a very nuanced rotation. We become so used to dealing with the objective and the tangible in our day to day practice that the abstract and intangible aspects of a patient’s health are often lost. However, if we dig deep enough, we often surprise ourselves with how many people struggle with psychiatric issues. It is definitely a weakness of mine and one that I will need to continue to improve in my later weeks in psychiatry.
For the time being, the psychiatry exam will be my focus.

Exam Tomorrow.

Psychiatry has been a very nuanced rotation. We become so used to dealing with the objective and the tangible in our day to day practice that the abstract and intangible aspects of a patient’s health are often lost. However, if we dig deep enough, we often surprise ourselves with how many people struggle with psychiatric issues. It is definitely a weakness of mine and one that I will need to continue to improve in my later weeks in psychiatry.

For the time being, the psychiatry exam will be my focus.

Tailored Presentations: Replies

  • Thumri: I like this post and think it is true, but from my experience, all of medical education is designed to help us avoid what you describe as the pain and shame of not knowing. I would be interested to know what you think would be a better way to summarize quickly and communicate about complicated patients.
  • ShrinkRants: ...I do wish standard medical practice were different. These tips, and the condensed presentations given as examples, are shot through and through with impersonal “objective” language. Such language hides the subjective nature of its collection. It works directly against any reflection on the discourses that shape what is included and excluded. It is all about knowing. The tips are offered in service of helping presenters look and feel knowledgable and avoid the shame of not knowing. The people the presentations describe are not present as people, as living breathing, hoping, fearing persons. They are reduced to a collection of facts, signs, and symptoms. This is not, cannot in this form be, “patient-centered medicine.” Until we as a profession change our everyday language, we will not be able to practice patient-centered medicine... (Read the rest at http://bit.ly/18M0bDz)
  • The shame of not knowing is pervasive but I would agree that it does not mean that it must remain an engrained part of this culture. There are positive ways of delivering feedback. It really depends on the doctor I work with. While subjectivity is generally excluded from these presentations, it helps bring the pertinent information to the forefront, the pieces that are most easily examined, investigated and followed. I always try my best to paint a picture of the person behind the presentation, to tell a story and not just a list of facts. From more descriptors to using a FIFE model to better understand this patient's subjective state, I try to keep them all intact, even if my audience is not completely interested. But the purpose is always to deliver concise presentation that informs enough for another doctor to draw his own conclusions and to do his job effectively. Having said that, some specialties simply do not lend well to subjective language at all in a presentation.