D-Slides Plenary 4
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Transcript D-Slides Plenary 4
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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