3 replies, 2 voices Last updated by Carl Aiken 3 years, 5 months ago
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    • #3619

      Michael Porter
      Participant
      @mkporter

      Puchalski has a lot of statistics in her article which show what we as Chaplains have known – Spiritual care is important for healing.  I appreciate her writing this for her colleagues to help them understand the need of spiritual care.  Her comments about the focus of medicine moving to a cure-oriented model because of the advancement of technology and the ability to prolong life, struck a nerve with me.  I struggle – as well as other members of the care team (even doctors) – with people who “want everything done” for their loved one, even though the doctor has told them that what is being done is futile.  People are being “kept alive” at all cost because the technology is there to do so and loved ones want done.  To use a known phrase – “Just because we can dose not mean we should.”

      I still struggle with families in these situations.  I sit with them.  I listen to their stories.  I help them reframe.  But many seem to hang on, waiting for the miracle – and the futile care continues.  My thinking is that the spiritual care need to begin before the situation in which they find themselves.  If Puchalski’s study has an impact on her colleagues, spiritual care can begin with the first visit a person has with a doctor.  This could be helpful in a crisis or end-of-life situation.

      Unfortunately we live in an age where doctors are pushed to see as many people in a day as possible.  This drives revenue and makes it difficult for relationships to develop.  I am fortunate to work with some doctors that still take the time with their people.  When I have been involved in an end-of-life situation with those people, they seem move through the process more easily.

      Puchalski is not a Chaplain, but she seems to have a heart for people under her care.  She at least gets it and she shows that in her summary.  I get the sense that she might feel she is a “lone wolf” in this, as if the doctor is responsible for the spiritual care process.  She refers to the use of a Chaplain, but I would be interested in hearing how she works with a team that includes a Chaplain.  She refers people to a Chaplain, but does she work with and collaborate with a Chaplain?

      I think the article is good for doctors to read and I hope it sensitizes them to a more holistic care approach with people.  I am glad to hear that spiritual care is beginning to make it into the education of doctors.

      Mike

    • #3627

      Carl Aiken
      Participant
      @CarlAiken

      Hi Michael

      You have identified what for me is a constant dilemma in healthcare – the issue of futile treatment. While there are some complexities in the question, there are also some that are quite clear. My wife and I have medical directives in place – basically a ‘turn me off’ order. And we have talked to our kids about it. It seems to me that often futile treatment is a collusion between docs who can’t stop and families who have unfinished business. And throw in the question of emotional intelligence….I wish there were a simple metric but there isn’t.

      Glad you work with some good docs…I think relating to them is a key, and building the bridges.

      Cheers

      Carl

    • #3636

      Michael Porter
      Participant
      @mkporter

      Hi Carl,

      Advance directives do provide insight to what a person’s wishes are.  I have experienced that families that override the advance directive of their loved one – especially those members who have “unfinished business.”  Unfortunately doctors tend to follow the family’s wishes fearing a lawsuit if they do not.   When I talk with family members, my approach is to as them what their loved one would want in this situation rather than the question that is typically asked:  “What do you want us to do for your loved one?”  The decision the team is looking for is ultimately the patient’s whether that comes from the patient or through their loved ones.  When I help people complete an advance directive I encourage them that having the talk with their loved ones before in a crisis  is important to let them know what they want.  I believe this conversation is also important for the doctors to have with the people under their care.

      Another question I raise with families is:  Are we prolonging life or dying?  These questions seem to help some people through the process.

      Mike

    • #3646

      Carl Aiken
      Participant
      @CarlAiken

      Hi Michael
      I think the unfinished business falls into the emotional intelligence basket – some will never be ready. Often what they do is prolong the suffering of the one they love. We have often asked, how much longer does (name) need to suffer? Of course that comes after a long, nuanced conversation.
      Having said that, in our shop it was always the senior docs who had those conversations, never the residents.

      Cheers

      Carl

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