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jerryking : hospice   17

How Doctors Die - Showing Others the Way - NYTimes.com
November 19, 2013 |NYT| By DAN GORENSTEIN

Patients and families often pay a high price for difficult and unscripted deaths, psychologically and economically. The Dartmouth Atlas Project, which gathers and analyzes health care data, found that 17 percent of Medicare’s $550 billion annual budget is spent on patients’ last six months of life.... “As a doctor you know how to ask for things,” he said. But as a patient, Dr. Billings said he had learned how difficult it can be to push for all the information needed. “It’s hard to ask those questions,” he said. “It’s hard to get answers.”

There is a reason for that. In his book “Death Foretold,” Nicholas A. Christakis, a Yale sociologist, writes that few physicians even offer patients a prognosis, and when they do, they do not do a great job. Predictions, he argues, are often overly optimistic, with doctors being accurate just 20 percent of the time.
hospice  dying  palliative_care  conversations  books  end-of-life  overoptimism  physicians  medical_communication 
november 2013 by jerryking
What to Say to a Friend Who's Ill - WSJ.com
April 12, 2013 | WSJ | By LETTY COTTIN POGREBIN.
The following are 10 Commandments for Conversing With a Sick Friend.

1. Rejoice at their good news. Don't minimize their bad news. A guy tells you that the doctors got it all, say "Hallelujah!" A man with advanced bladder cancer says that he's taking his kids to Disneyland next summer, don't bite your lip and mutter, "We'll see." Tell him it's a great idea. (What harm can it do?)..."Tell me what I can do to make things easier for you—I really want to help."

2. Treat your sick friends as you always did—but never forget their changed circumstance. Speak to them as you always did (tease them, kid around with them, get mad at them) but indulge their occasional blue moods or hissy-fits. Most important, start conversations about other things (sports, politics, food, movies) as soon as possible and you'll help speed their journey from the morass of illness to the miracle of the ordinary.

3. Avoid self-referential comments. A friend with a hacking cough doesn't need to hear, "You think that's bad? I had double pneumonia."...The truest thing you can say to a sick or suffering friend is, "I can only try to imagine what you're going through."

4. Don't assume, verify. Repeat after me: "Assume nothing."

5. Get the facts straight before you open your mouth.Did your friend have a heart or liver transplant? Chemo or radiation? Don't just ask, "How are you?" Ask questions specific to your friend's health. "How's your rotator cuff these days?" "Did the blood test show Lyme disease?" "Are your new meds working?" If you need help remembering who has shingles and who has lupus, or the date of a friend's operation, enter a health note under the person's name in your contacts list or stick a Post-it by the phone and update the information as needed.

6. Help your sick friend feel useful. Zero in on one of their skills and lead to it. Assuming they're up to the task, ask a cybersmart patient to set up a Web page for you; ask a bridge or chess maven to give you pointers on the game; ask a retired teacher to guide your teenager through the college application process. In most cases, your request won't be seen as an imposition but a vote of confidence in your friend's talent and worth.

7. Don't infantilize the patient. Never speak to a grown-up the way you'd talk to a child. Objectionable sentences include, "How are we today, dearie?" "That's a good boy." "I bet you could swallow this teeny-tiny pill if you really tried." And the most wince-worthy, "Are we ready to go wee-wee?" Protect your friend's dignity at all costs.

8. Think twice before giving advice.Don't forward medical alerts, newspaper clippings or your Aunt Sadie's cure for gout. Your idea of a health bulletin that's useful or revelatory may mislead, upset, confuse or agitate your friend. Sick people have doctors to tell them what to do. Your job is simply to be their friend.

9. Let patients who are terminally ill set the conversational agenda.If they're unaware that they're dying, don't be the one to tell them. If they know they're at the end of life and want to talk about it, don't contradict or interrupt them; let them vent or weep or curse the Fates. Hand them a tissue and cry with them. If they want to confide their last wish, or trust you with a long-kept secret, thank them for the honor and listen hard. Someday you'll want to remember every word they say.

10. Don't pressure them to practice 'positive thinking.' The implication is that they caused their illness in the first place by negative thinking—by feeling discouraged, depressed or not having the "right attitude." Positive thinking can't cure Huntington's disease, ALS or inoperable brain cancer....As one hospice patient put it, "All I want from my friends right now is the freedom to sulk and say goodbye."
bad_news  conversations  Communicating_&_Connecting  difficult_conversations  dignity  etiquette  hospice  ice-breakers  illness  positive_thinking  stressful  tension 
april 2013 by jerryking
Die the Way You Want To
January-February 2012 | Harvard Business Review |by Ellen Goodman.

Taking charge of your last days eases everyone’s burden.
dying  hospice  palliative_care  end-of-life 
may 2012 by jerryking
Healthy Reader
April 3, 2012 | WSJ | By LAURA LANDRO

Exit Strategies In his new book, "The Best Care Possible," Ira Byock, a professor at Dartmouth Medical School and an expert on palliative care, is nothing if not blunt: "Americans are scared to death of dying. And with good reason," he writes. "We make dying a lot harder than it has to be." This remarkable book, subtitled "A Physician's Quest to Transform Care Through the End of Life," begins by explaining why our current methods of caring for people with advanced illnesses are "dysfunctional" and "neglectful." (Among the biggest problems: Busy clinicians tend to give short shrift to communicating fully with patients, treating pain or coordinating tests and office visits.) Then, through a series of exchanges with patients and their families, Dr. Byock illustrates how the medical community and society can "make the best of what is often the very worst time of life." An absorbing read.

To learn more visit irabyock.org.
book_reviews  books  Communicating_&_Connecting  dying  end-of-life  hospice  Laura_Landro  medical_communication  palliative_care  physicians  wellness 
may 2012 by jerryking
Stephens: A Lesson Before Dying - WSJ.com
December 13, 2011 | WSJ | By BRET STEPHENS.

A Lesson Before Dying
To bemoan illness after a good life seemed ungrateful.

"The good death has increasingly become a myth," wrote the Yale surgeon and bioethicist Sherwin Nuland in his 1993 prize-winning book "How We Die." Dying, in Dr. Nuland's eloquent telling, amounts to "a series of destructive events that involve by their very nature the disintegration of the dying person's humanity." Who can—who would dare—judge a man's worth when his mind and body are being picked bare by disease?...Cancer is a heist culminating in murder....To grow up is to understand that the confidence a parent radiates around his children is rarely the confidence the parent feels. I knew my father well enough to know his various fears and insecurities...All this meant that the diagnosis should have been devastating to him. Yet he never betrayed the slightest sign of fear...Yet my father maintained his usual sangfroid even when it became clear that there would be no getting well. There were no five stages of grief, no bouts of denial, anger, bargaining and depression....Throughout his life my father taught me many lessons: about language, history and philosophy; about ethics, loyalty and love. In the end, he taught me that death cannot destroy the dignity of a dignified man.

Charles J. Stephens, 1937-2011. May his memory be for a blessing.
dying  deaths  hospice  lessons_learned  cancers  Bret_Stephens  fatherhood  grief  palliative_care  end-of-life  books  dignity 
april 2012 by jerryking
Hospice medical care for dying patients
August 2, 2010 | The New Yorker | Atul Gawande

In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. ...And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.”

People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others.
Atul_Gawande  cancers  caregivers  dying  end-of-life  healthcare  hospice  medical  palliative_care  quality_of_life 
august 2010 by jerryking
Making Sure Patients Don’t Die Alone - Well Blog - NYTimes.com
June 3, 2010 |NYT | vy TARA PARKER-POPE. From the
comments..."The prospect of imminent death is probably the most
frightening thing that all human beings must eventually face. And to do that alone is tragic. It is good to know that the medical profession is aware that the care given to patients must not only deal with their medical needs but with
their emotional and spiritual needs as well. Everyone wins. Thank you.
— Maxine Howland"
compassion  deaths  palliative_care  hospice 
june 2010 by jerryking

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