Friday, August 7, 2009

I'm not ready for hospice!

This morning we had a discussion in the department about how to have the ideal hospice discussion. The author of this article was the presenter. It was an interesting thoughtful discussion based on the premise that doctors and patients often have a tough time communicating. One of the ideas that I really try to teach medical students is that the key to being a good doctor has to do with normal people skills.

The most important thing that I try to teach is that physicians don't need to know what to say, or how to have a conversation but how to listen (actively). In some ways, it is not all that different from being married. I don't need to do studies to research why my wife is angry at me, or figure out what has worked for most angry wives, I just need to ask her what's wrong and listen. Or if she's happy, what's right!

So here's my list of things doctors should do when discussing something difficult like hospice:
1. Listen, don't talk
2. When the physician is talking, the goal should be to seek further clarification of what the patient (and/or family member) was saying
3. Figure out what the patient's goals are
4. Discuss goals of care all the time, not just when the physician has a goal for the patient
5. Emphasize that the physicians goal is to help the patient carry out his/her goals.
6. If you're not sure how a patient is going to react to something, be honest about that. i.e. I'd like to bring up the issue of hospice but I'm not sure how you're going to feel about that? Or how do you feel about discussing hospice?

The goal at the end of the day is to not cram anything down a patients throat in a manipulative fashion but empower the patient by helping them maintain autonomy and control. Communication can achieve either the former or the latter. Somehow in this day and age, with all the pressures (legal, financial etc.) that doctors face, listening has become a lost art.

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