Monday, December 01, 2008

"The most important part of my job"

I know I have overloaded you a bit with end-of-life issues, but I want to share two articles on the subject. The first is a very nice post by Bob Wachter, entitled My Patients Are Dying... And I've Never Been Prouder.

The second is an article written by BIDMC's Dr. Richard A. Parker. It is in the Annals of Internal Medicine, Volume 136, Number 1, 1 January 2002. I include excerpts from the introduction and the conclusions here, which are elegantly stated.

Quality end of life care benefits patients, families, and physicians. Fear of abandonment, indignity, pain, discomfort, and the unknown trouble most of us when we contemplate dying and death. In my primary care practice at an urban teaching hospital, I have cared for 95 patients who have died over the past 12 years. I believe that relationships among the patient, doctor and family built over time usually allow a “good death,” and almost always prevent unwarranted resuscitation, futile interventions, and unnecessary suffering. I now view the end of life not as failure for either patient or doctor, but as a valuable opportunity for growth, insight, and closure.

Death is the bookend experience to birth, yet we are far from our agrarian roots, where the cycle of birth and death was a normal part of daily life. Our society celebrates and worships birth but flees death as if it were avoidable. And the only person empowered to directly assist in navigating life’s end, the physician, with skill and caring, must bring meaning and solace to patients and families as death looms.

Daily, physicians strive to comfort, diagnose, treat, cure, and extend life with quality. Yet we must recognize when to shift to palliative care. Patients expect, hope, and trust that their doctors are versed in dealing with end of life issues, but physicians need to learn and practice these skills. How ironic that doctors rarely, if ever, talk about dying amongst ourselves even though are patients expect to be experts in such care.

Keeping a record of all my patients who have died has helped me honor their memory and reminds me of the lessons they have taught me. Collecting such a history also sheds light on issues deserving improvement, such as instituting a home visit near the end of life. Regardless of the inexorable march of technology, birth and death will continue to bound our existence. Our society awards to physicians the authority and privilege of caring for people at the end of life. I have learned that caring for patients in the last chapter of their lives is the most important part of my job.


HMS said...

Greeting - Just want to say what an honor it is to see hospital administrators such as yourself who strives to improve the welfare of patients and health professionals in the broken system that we are in. Your efforts are appreciated, sir!

Unknown said...

I keep the names and phone numbers of all my patients in a small looseleaf notebook in alphabetical order, one page per patient. When a patient dies, I move the page to a special section. Every once in a while, I "visit" this section, and reminisce.