Skip to main content

A Chance to Finish the Business of Living

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 undone in your life?," and (4) "How are things going for you and your family?" Document and arrange care to meet each patient's priorities.

All too often the task of finishing the business of living gets left undone because the end of life conversation has never taken place for whatever reason. I strongly recommend reading Dr. Berwick’s 20 recommendations and sharing them widely.

You can find Berwick’s the full article on the website Americans for Better Care of the Dying at the link below:
http://www.abcd-caring.org/tools/intern.htm
Labels:

Popular posts from this blog

CMS Regulations Relating to Clinical Pastoral Education & Medicare Pass-Through Payments

There remains considerable confusion concerning which Clinical Pastoral Education training programs qualify to receive Medicare Payments. The leadership of the Association for Clinical Pastoral Education has not acted in a responsible manner to clear up the misunderstanding; promoted by ACPE leaders; that only ACPE accredited Doe recognized programs qualify for such payments. Clinical Pastoral Education training programs accredited by The College of Pastoral Supervision & Psychotherapy also qualify for such payments. Medicare officials do not support the ACPE only claim. We quote a response provided from the Medicare office: “The regulations cite the ACPE as an example of a national professional organization that would be sufficient as the accrediting body. However, the regulation at section 413.85(e) also specifically state that the accrediting bodies are “not limited to” the cited organizations. While programs that are accredited by the ACPE meet CMS definition of an Approved Nur...
Read more

Health Care Reform Inflammatory Language

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...
Read more