The Coat Check

Communication in Healing: Principles in Practice

This past week Boston University School of Management first year Health Sector MBA students began their required HM703: Health Sector Issues and Opportunities required course. This class is intended to introduce students to a general, holistic overview of the health care field, touching on the various complex disciplines: service delivery, pharmaceuticals, medical devices, and related topics include the Accountable Care Act. The first in-class assignment for the course following the introductory lecture was to choose any professional organization, advocacy group, or other entity with a vested interest in end-of-life issues. This is an extremely sensitive topic, as indicated by the mythos that has persisted surrounding supposed ‘death panels’ touted about by none other than Sarah Palin.

One by one, each presenting team spoke to the complexities of patient care and the need for engagement between patients, family members, and providers regarding end-of-life wishes. Indeed, this difficult circumstance is a topic which frequently causes tensions to escalate, given the severe stresses involved for all concerned and the often desperate hope by patients and their family that some new cure might be just over the horizon.

The Executive Director of White Coat Checklist has spoken with hospital chaplains who have experienced extremely difficult stories of the additional suffering inflicted by a stubborn willingness to cling to every moment. In one extremely troubling case, an elderly woman with a weak heart had gotten her family to agree to let her go – and signed that very difficult-to-undertake ‘DNR’ or ‘Do Not Resuscitate.’ When her heart did eventually spasm, however, her children exercised their rights as her health care proxy to override the DNR and bring her back. The chest compressions required to bring her back broke several of her ribs. She suffered in constant pain for another two weeks before finally slipping away. The sad truth is that a good death can be as rare as Aristotle’s ‘life well lived.’

It should be clear from even a cursory review of such situations, as difficult as they may be, that strong communication skills and the courage to give difficult news go hand in hand with the medical profession. There is no discipline of medical care removed from the context of pain, loss, or suffering. In addition, such resources as chaplaincy, social work, home care, hospice, palliative care that are there to support medical professionals in such discussions are often under-utilized or never accessed, with corresponding impact on quality of life. We all would do well to remember that new guidelines that give patients and family members a greater voice in their care are not 100% positive: these can be at least partially credited with a sharp increase in pain medication prescriptions and drug seeking behavior in addition to priorities at odds with public health concerns as well as publicized resistance to vaccination despite clear clinical outcomes which stand up under the most rigorous clinical scrutiny. White Coat Checklist is here to help aspiring physicians to help them find their voice, as they will most assuredly have need of it in years to come. 

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