Saturday, October 3, 2009

An Attempt to Balance the Signal-Noise Ratio Surrounding Palliative Care

While it has taken years to popularize the word "palliative" (I have to confess that the word still does not roll nicely off my accented tongue), it is remarkable how the recent negative press related to the issues addressed in the Newsweek article on rethinking end of life care have managed to gain significant traction swiftly. I worry that all this sensationalism will distract from real and important discourse on sensitive topics like exploring the underlying suffering beneath patients' requests for hastening death. On a related note, Dr. Susan Block from Harvard Medical School has authored a very timely video module entitled : Patient Requests to Manage Life's Final Chapter: Assessment and Palliation. The module is hosted on a Stanford curricular LMS, please note that you have to register and sign up to get access to it (takes 2 business days) . On a positive note, the module is free full text and has a interactive video case study intertwined into the module, pre and post test video questions. See below for sample clip: video
Case study: The clip above is about Emily, a 56 year old dancer with advanced ovarian cancer s/p multiple rounds of chemo with minimal response. After struggling with multiple distressing symptoms due to the cancer and the treatments for almost three years, Emily decides to stop chemotherapy. Her oncologist, Dr. Stevenson (played by the extremely talented oncologist, Dr. Beth Martin, from Stanford), wants to start Emily on a promising experimental chemotherapy agent. However, Emily just stops coming to her Oncology appointments and instead writes a letter to Dr. Stevenson asking for help with hastening her end. Dr. Stevenson, who totally did not see this coming, is taken aback and reaches out to her colleague and palliative care expert, Dr. Susan Block. Check out the video clip above to see a conversation between Dr. Stevenson and Dr. Block (played by the extremely talented Dr. Susan Block from Harvard).
Case study credits: Case written, directed and produced by VJ Periyakoil, MD.All characters ( except Dr. Block's character) appearing in this case study are fictitious. Any resemblance to real persons, living or dead, is purely coincidental.

4 comments:

Patrice Villars said...

This video is a beautiful example of the type of caring and communication we all strive to achieve. Without using a direct patient interaction, we see how Dr. Block compassionately addresses both the emotional component of the oncologist's response and opens her to the possibility that the patient may have more going with her psychologically/spiritually than her cancer treatment addresses. THIS is what palliative truly is. It's not about dying or a particular agenda for care. It's about seeing the whole picture....individually, fully, and compassionately. So, yes, let's get THIS message out to the media, to our colleagues, and to our patients/families. Thank you for this post.

VJ Periyakoil said...

Folks:
Just for clarity, in the actual module, there are examples of multiple patient interaction between the patient, her husband, her daughter, Emily's friend Katie ( a Nurse) and Drs. Block and Stevenson ( played by Dr. Beth module). There is a meeting between Emily and her doctors when Dr. Block beautifully demonstrates exactly how have a end of life care plan meeting with a patient who is clearly suffering tremendously.

Alex Smith said...

Enjoyed the video, VJ. Always inspiring to see Susan Block "in action." I registered at the site - couple of glitches registering that I left some feedback about. Looking forward to seeing the videos. I hope to use these as teaching tools.

Dan Matlock said...

Dr. Block definitely modeled good communication. While I hope I succeed, I do find that I have to actively manage and suppress my frustration with specialists who want to push their agendas onto patients. A particular challenge of palliative care.