Transcript D-Slides Plenary 4

E
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The Project to Educate Physicians on End-of-life Care
Supported by the American Medical Association and
the Robert Wood Johnson Foundation
Plenary 4
Next Steps
Objectives

List the important themes from the
conference

Identify barriers to good end-of-life
care

Develop potential solutions
EPEC themes, next steps

Relief of suffering is a goal of
medical care

Palliative care knowledge is now
extensive

Role of families

Teamwork

Physician as patient advocate
Relief of suffering

4 dimensions
physical
psychological
social
spiritual

Expected by patients, families
Palliative care

Not the absence of care

More powerful than ever in the
history of medicine

A positive, humanistic philosophy

Technically sophisticated area of
expertise
Families . . .

How we die is an important personal
legacy

Dying well often demands
the chance to be close to family, friends
family / proxy assistance with decisions
good communication
. . . Families

None of this is possible without good
symptom management
Teamwork . . .

The whole person goes through the
dying process, not just his / her
physiology

No one person can meet all the
needs
. . . Teamwork

Teamwork usually includes
physicians
nurses
social workers
chaplains
others

Hospice philosophy can be
integrated into mainstream practice
Advocacy

Professional duty to patient care

Professional duty to ensure
availability of services

Personal desire to be able to die with
quality care
Barriers

Institutional

Regulations

Reimbursement

Attitudes
Physicians’ personal
support needs . . .

Patients are asking us to do better

Find a forum for candid discussion
of experiences

Transference is powerful; personal
comfort is important
. . . Physicians’ personal
support needs

Professional distance, empathic
closeness must balance

Know yourself
Action Plan
Barrier
Plan
Barriers

“I” = Institutional

“O” = Others

“U” = Personal
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Next Steps
Summary