Using a Patient Perspective to Improve Palliative Education: Helping Patients Go into That Good Night

Abstract

T HE PUBLIC ATTENTION TO AND SUPPORT OF physi-Medical education needs to provide students cian-assisted suicide suggests that many are and residents with knowledge, experience, and not as afraid of dying as they are of how they die. perhaps most importantly, examples of excelDespite this, physicians consistently fail to meet lence in care for the dying. This task is most aptly the needs of dying patients. 1 " 3 Death is often pre-accomplished during clinical years of training ceded by significant, chronic illnesses, so most where students learn to apply factual knowledge people frequently encounter physicians in the fi-and develop clinical acumen by participating dinal months or years of their lives. These interac-rectly in patient care and by observing others protions provide physicians with numerous oppor-vide patient care. During the clinical years many tunities to educate patients about the natural students use faculty as examples for developing progression of their disease, prepare them for the clinical habits and setting clinical priorities. 5 Undevelopment or worsening of their symptoms, fortunately, palliative care receives sparse attenand even help patients anticipate the expected na-tion during these years and has relatively few f acture of their final decline and demise. Many ulty mentors. A palliative care course that spans physicians, however, fail to recognize or utilize the third and fourth years of medical school these encounters as opportunities 3 to help pa-would provide an alternative model of care for tients prepare for death and define the goals of the dying, heighten student awareness of dying medical care at the end of life.patients' needs, and encourage students to ad-A careful look at clinical training reveals that dress these needs with all patients. In order to medical education fails to define the physician's create such a course, one must first recognize the role in caring for the dying and creates an envi-numerous obstacles to teaching and learning palronment that discourages students and residents liative care in the current environment of physifrom addressing patients' palliative needs. Pal-cian training. liative medicine is defined as "the study andThe hospital, home to much of clinical training, management of patients with active, progressive, provides medical students with a distorted view far-advanced disease for whom the prognosis is of death. A majority of patients die in the hospilimited and the focus of care is the quality of tal, 6 -7 but patients rarely come to the hospital prelife." 4 Ideally physicians should strive to address pared to die. Unless a patient's chart is stamped the quality of life for all of their patients, regard-with bold documentation to the contrary (ie, less of how advanced or curable their illness may DNR/DNI orders), physicians assume that pabe. Physicians who fail to recognize and address tients desire treatment. Too often palliative opthe palliative needs of dying patients likely over-tions are not explored until after multiple atlook critical qu...

The final chapter

“…Scholars have argued that U.S. culture is a death-denying society (Ochs, 1993;Ragon, 1983;Tucker, 2009) because denial has and likely will always be evident in discourses surrounding dying and the endof-life (Zimmerman, 2004). Although some scholars question how pervasive this 'deathdenial' thesis actually is (Kellehear, 1984;Zimmerman & Rodin, 2004), it is clear that a discomfort with death is evident in U.S. culture today as scholars argue that death and dying conversations are relatively absent from everyday talk (Bern-Klug, 2004;Tarzian, Neal, & O'Neil, 2005), and interactions with physicians often lack candid conversations about death (Buss, 1999;Iedema, Sorenson, Braithwaite, & Turnbull, 2004, Tucker, 2009). Instead, biomedical agendas which focus on cure are highlighted, suggesting that while the post-colonial turn offers individuals freedom in how they make meaning of their illness experiences, illness experiences and identity constructions for individuals nearing the EOL might still be colonized by biomedical discourses in illness narratives.…”