Palliative Care Conversations

Sometime ago Don Berwick, MD spoke about 20 improvements that doctors could make in the end of life care of their patients that begins in a simple conversation. Berwick recommended the following considerations as his top three suggestions: 1.Ask yourself as you see patients, "Would I be surprised if this patient died in the next few months?" For those "sick enough to die," prioritize the patient's concerns - often symptom relief, family support, continuity, advance planning, or spirituality. 2.To eliminate anxiety and fear, chronically ill patients must understand what is likely to happen. When you see a patient who is "sick enough to die" - tell the patient, and start counseling and planning around that possibility. 3.To understand your patients, ask (1) "What do you hope for, as you live with this condition," (2) "What do you fear?," (3) It is usually hard to know when death is close. If you were to die soon, what would be left

Health care reform is a scary subject for ordinary Americans and this is not been helped by the tone of the current national debate on this issue which has turned terrible nasty. One of the most heated concerns to have emerged recently relates to end-of-life conversations. End-of-life conversations are difficult at the best of times and made all the more difficult in these uncertain days of economic upheaval when many Americans have lost their jobs, health care insurance and homes. Unfortunately, some public figures and national leaders have chosen to offer their critique of the proposed health care reforms using only the most inflammatory language possible. The tenor of this debate does not bode well for the American public in terms of any real substantial change to a health care system which is too costly to sustain and unequal in terms of access. These difficult days call for true leadership which does not fail for lack of nerve to embrace the courage of change in the best interests