Love in the Afternoon
August 29, 2011 | 
Author
Start any day on Palliative Medicine, and you already know that your day is anything but that which you might otherwise predict.
Family meeting, half past nine, but no family there. Read the rest of this entry »
Schedule that important family meeting strategically to overcome decisional fatigue.
I have always known that 3PM on the Friday before a long weekend is the absolute worst time to get a new consult. I now know why, thanks to the recent NY Times article on Do You Suffer From Decision Fatigue? Here is the Cliff notes version of the article.... Read the rest of this entry »
Reflections on a 9th Grade writing assignment
My first assignment in "advanced 9th grade English" class was to write a 1 page description of a scene. No plot, just a description trying to include all of the senses using words. I had NEVER been in an ICU, never had anyone close to me pass away, and had as much medical knowledge as you'd expect a 9th grader to have. Yet, .... Read the rest of this entry »
Thoughts from a clinical trials course (and hello!)
Today, I am thinking about clinical trials because I am at a clinical trials class. It is a fabulous way to make you realize you don't know much. The course was extremely focused on pharmacology, but we also spent some time talking about "end points." As usual, folks interested in "quality of life" were having a difficult time defending outcome measures. Read the rest of this entry »
Great News!
Hospice expenditures from Medicare are up 70% from 2005 to 2009.
That’s great news. Hospice patients are usually much more satisfied with their care and have fewer unmet needs than those not in hospice. Hospice patients also cost Medicare less... Read the rest of this entry »
Of Pilgrims and Palliative Care
I am away on vacation in Spain while writing this and I love to walk. I was recently on a long walk with friends and family during which I had lots of time to think. The walk just happened to be part of the large network of paths that form the pilgrimage routes of Santiago de Compostela.... Read the rest of this entry »
Tags: 
An Uncomfortable Topic
must confess that I never ask my elderly patients or those in hospice about sex and only tell if they bring it up first. Oddly I’m a little squeamish about religious issues too, though I can carry spirituality all day long. Read the rest of this entry »
Letting go…
She is eating her lunch, as I interrupt that lunch.
Yet, she, she already knows.
Already knows that some kind of cancer, maybe lung from above, maybe pancreatic from below, has already charted a path from here to tomorrow. A path other than the one she and her husband of some fifty years might otherwise have wished, have ever imagined. Read the rest of this entry »
Posted in Cancer, Communication, General, Humanistic medicine, Patient Centered Care, Reflective practice | 
Comments Closed
Opinion: Pain Control at End of Life OR The Blue Angels?
Defence spending goes far beyond protecting the USA from terrorist attacks. Full disclosure here, I didn't grow up in a culture of air shows or in th military, and I feel strongly that the environmental impact (noise and pollution) far outweighs the awe of the show. The US population needs to embrace the fact that we are in a place of making dire choices - the thrill of the show or the ability to effectively treat a new cancer diagnosis and not go into debt or as I started this piece, to have a dignified end of life experience. Read the rest of this entry »
In the spotlight
Congratulations to the JPM bloggers for your excellent posts in the last two week:
Lisa Fields: July 22 to 28 , 2011
Maureen Horgan : July 29 to Aug 4 2011
Ryan Weller: July 29 to Aug 4, 2011
Read the rest of this entry »
Communicating Hope with Words-Clinical Practice Strategies
It is not uncommon at a first meeting for a parent/family member to apologetically state, “We are hoping for a miracle.”
This statement is an opportunity to join and promote that hope with a statement such as, “As you think about your child’s illness, can you tell me more about what you are hoping for? I would like to hope right along with you.” Read the rest of this entry »
Casualties of a different kind – care givers experience PTSD
“I can’t breath, I can’t drive, please help me”. These are the words of distress from the mother of 4 year old who died 5 weeks prior from “natural killer cell leukemia”.
She called me from the side of the road and described to me recurring images she was experiencing of the last moments of his life Read the rest of this entry »
Life Review: When Trauma Is a Part of the Story
The first veteran I ever worked with was not an American veteran, but a veteran of the British Royal Air Force (RAF). I was working for a hospice in London, and we were caring for “Roger,” a man who lived alone and desperately wanted to die in his own home. Our team provided him the around the clock care for the last two weeks of his life so this wish could come true. When I first met Roger he was not speaking to anyone Read the rest of this entry »
Champions of Hope
“Are you afraid you will destroy our hope? We create our hope. You are not a limiting factor in our sustaining hope.”
The “clinical “trick” that this mother and families desire clinicians to practice is being present with compassion while disclosing prognosis and all treatment options including palliative care options. Read the rest of this entry »
Subscribe Free: JPM Updates
Follow this JPM Blog
