Lessons On Dying. What Patients Taught Me That Was Missing From Medical School. By Amberly Orr

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1 Lessons On Dying { What Patients Taught Me That Was Missing From Medical School By Amberly Orr

2 Carve your name on hearts, not tombstones. A legacy is etched into the minds of others and the stories they share about you. { Shannon L. Alder

3 Thesis The topic of dying is a subject that is underexplored in medical school. Current education does not prepare medical students as they enter residency to have frank discussions about death with their patients and families. By integrating patient narratives into the interaction between the physician and a terminally ill patient, both can find meaningful ways to cope with dying.

4 Our culture of dying 80% of Americans prefer to die at home. 60% of Americans die in acute care hospitals, 20% in nursing homes and only 20% at home. Patients are spending more time in the ICU in the last 90 days of life. Less than one in three Americans have a living will.

Narrative medicine In the book Narrative Medicine, Rita Charon argues that listening to stories of illness helps doctors to recognize patients and diseases, convey knowledge, accompany patients

5 Narrative medicine In the book Narrative Medicine, Rita Charon argues that listening to stories of illness helps doctors to recognize patients and diseases, convey knowledge, accompany patients through the ordeals of illness, and can ultimately lead to more humane, ethical, and effective health care. At MD Anderson, palliative care patients work with artists to produce poetic narratives on topics that help them cope with dying.

6 On Family Family members are an important but often overlooked aspect to patient care Studies show that up to one-third of partners and one-quarter of children of palliative patients can experience significant psychiatric morbidity.

7 On Family My image is of cooking and baking. I cook everything. It relaxes me, and it interests me. I do it for my family. She survived more than two decades, and she had two stem cell transplants. She was able to see her sons grow up, get married, and have kids. My image is of a hawk. It s very special to my husband and me. I believe it will be my connection to my husband.

8 On Doctors Physician s choice of words and display of empathy has been shown to impact decision-making by the patient and their families. Expression of empathy and a strong physician-patient relationship has been linked to better patient outcomes, greater treatment adherence, lower physician burnout and lower rates of malpractice suits. Patients regarded doctors that took a course on empathy as more understanding and comforting than those doctors who had not taken the course.

On Doctors In His Arms I think I have the best doctors in the world. If there was a way to save my life, They would have done it. I have a good team behind me.

9 On Doctors In His Arms I think I have the best doctors in the world. If there was a way to save my life, They would have done it. I have a good team behind me. These doctors are passionate about their patients. My doctor takes the time To explain what s going on. He asks me if I understand what he s telling me. Before I leave the room, Both of us are almost in tears. That kind of care is amazing. Sometimes I think God put me in his arms.

10 On Religion Cancer patients are less likely to die in an ICU if their spiritual needs are addressed. Studies show most patients with a serious illness want their spiritual issues addressed. Results in increased trust in physicianpatient relationship, feeling that their wishes are respected, and feeling hopeful.

11 On Religion His strong point is his faith. It keeps him grounded and directed. He knows where he s going, which makes it easier for us. One thing that s really special to me is my church, and when I see a cross I see visions of love and caring.

12 Conclusion While the topic of death is difficult in our culture, it is important for both physicians and their patients to be able to discuss end-of-life care. Narrative medicine is a way to help physicians understand the dying process better, and a way to help terminally ill patients and their families heal.

13 References 1. Balboni T, Balboni M, Paulk ME, et al. Support of cancer patients' spiritual needs and associations with medical care costs at the end of life. Cancer 2011; 117: Barnato, A., & Arnold, R. (2013). The Effect of Emotion and Physician Communication Behaviors on Surrogates Life-Sustaining Treatment Decisions: A Randomized Simulation Experiment. Crit Care Med., Brennan, M. (2017). Life at the End of Life. Chicago: Intellect. 4. Charon, R. (2008). Narrative Medicine: Honoring the Stories of Illness. New York: Oxford University Press. 5. Kissane DW, Bloch S, Burns Wl, McKenzie DP, Posterino M. Psychological morbidity in the families of patients with cancer, Psycho-Oncology, 1994, vol. 3 (pg ). 6. McCord G, Gilchrist VJ, Grossman SD, et al. Discussing spirituality with patients: a rational and ethical approach. Ann Fam Med 2004; 2: National Center for Health Statistics. Health, United States, 2010: Chartbook with special feature on death and dying. Hyattsville, MD National Consensus Project for Quality Palliative Care. (2009). Clinical Practice Guidelines for Quality Palliative Care. (2nd). Pittsburgh, PA, USA. 9. Nuland, S. (2014). How We Die: Reflections on Life's Final Chapter. New York: Chu Hartley LLC. 10. PRNewswire. (2016, March 21). Nearly Two-Thirds of Americans Don't Have Living Wills --Do You? Retrieved February 2017, from American College of Emergency Physicians: Wills-Do-You 11. Riess, H., & al., e. (2012). Empathy Training for Resident Physicians: A Randomized Controlled Trial of a Neuroscience-Informed Curriculum. J Gen Intern Med, Silvestri GA, Knittig S, Zoller JS, Nietert PJ. Importance of faith on medical decisions regarding cancer care. J Clin Oncol 2003; 21: Teno JM, Clarridge BR, Casey V, et al. Family perspectives on end-of-life care at the last place of care. JAMA. 2004; 291(1):88-93.

Addressing spiritual concerns in care of patients at the end of life

Addressing spiritual concerns in care of patients at the end of life July 22, 2013 Farr Curlin, MD The University of Chicago Background - George Engle: Biopsychosocial Medicine (1977) - Health > biology