This time of year the hospice team expects IDT meeting to extend a bit longer. Staying true to form, I’m bringing ideas from the annual AAHPM assembly home.
Here are my top 3 take homes:
1. A new thing to try: Lesson from The Oliver’s Story
The first thing I read from morning report was “please call the patient’s daughter…she is having a difficult time…she is telling family about cancer”
The most poignant part of Oliver’s story was the discomfort of those around him with the news of his cancer. The idea of how people react to the strangeness of death is not new but honestly something I have not paid significant attention. David Oliver played the role of comforter. I will make a concerted effort to ask patients how those around them are reacting to their illness and how they are coping with other’s strangeness to death.
2. A validation: Billings and Block, advance care planning may be “too soon”
I followed this on twitter and afterward discussed with some that attended this session. I believe Block and Billings stated that advance care planning may be “too soon”. While this may ruffle many feathers, it validates my experience.
A quick thought experiment:
Values + Preferences = Goals
Goals + Preferences = Values
Perhaps none of the above is true.
In my experience values is more constant where goals and preferences are relative to narrative and context. Goals and preferences change. An advance directive measures preferences not necessarily values. In many of my patients, regardless of AD or not, I’m having conversations sussing out values with patient and family. The harm of having an AD that is “too old” is that opportunities for these conversations may be passed and values may be misguided. In regards to having a health care proxy, I don’t believe that this can be done “too soon” but at the same time, there are many times the assigned health care proxy may not truly understand the patient values so values are determined by a gestalt.
I am for advance directives, just not “too soon”.
Feel free to flame away.
3. An inspiration: Biren Saraiya, Google Chat
Biren is using google chat to teach oncotalk principles. I think this can actually scale from a teaching tool to an actual patient/physician conversation tool. Language and nuances are evolving in chat written speech chat. (there is a nice TEDtalk on this, but I can’t find it!). Patients can actually have a pretty strong connection over chat, maybe even stronger than phone. While never as good as face to face, I think it can scale. That pumps me up.
What are your top 3 take homes?