By 17 Feb
1. Watch the show, Being Mortal, which airs tonight, Tues 10 Feb at 10pm (or watch later streaming online). http://www.pbs.org/wgbh/pages/frontline/being-mortal/
2. Analyze the show using our reading by Childress & Siegler (presented by Emily in class on Mon 9 Feb). What models/metaphors describe most end-of-life care in America today? Would it be better to use a different metaphor? Explain.
By 24 Feb
3. Respond to at least 2 of your classmates' posts; develop the conversation by addressing one or more of the following:
* What has surprised you about the content of the video or your classmates' response(s)?
* What is the role of medicine? How should it address aging and dying? Gawande says they are unfixable. Does that mean there is nothing to do about them?
* What was the most optimistic part/message of the video?
The model of the physician patient relationship that i think was used within the video being mortal is the partnership. This model allowed patient to keep their autonomy within the tragic experience of dying of a personal illness. The physician's focus in the video is to allow the patient to express what is important to them at the end of their life. The priorities that each patient has towards the end of their life. Two of the patients in the video wanted to die at home and made that clear to the physicians and they made it happen. Another patient wanted to take her grandchild to disney world and the physicians were unable to make that happen because both the patient and the doctors knew that she was continuing to get worse and would be unable to leave the hospital. The doctors used many different forms of communication they knew how to act in each situation when to give hope and when to stop giving hope and explain how it is close to the end. A part of the video that was the most interesting to me was when the author had the doctors watch videos on their communication with the patients and understand in those moments why they said what they said and when silence was used. As nurses we use what we call therapeutic communication which allows nurses to get to the point of the problem for a patient well still establishing their autonomy. I think in the United States the main type of patient physician communication is used is the parentalism because the doctors explain and the patients usually do not argue because they are not given enough information on their illness. I think the doctors in the video the way they were with their patients was excellent. They were emotionally available and willing to help and understand their priorities. It was a partnership between the patient, physician, and family of the patient understand each others needs and wants and what the doctors were able to provide for them. It was how healthcare should be practiced according to how i would want doctors to treat me in situations as seem in the video.
ReplyDeleteI agree with your statement about both of the doctors in the documentary being awesome in how they handled their communication with their patients. They didn't try to rush their patients or push their own thoughts and opinions on them, they gave them information and even if they didn't agree with the decision a patient made (such as the man with brain cancer wanting to attempt an experimental treatment), the physician still said they would look into it. This, to me, was the epitome of allowing a patient to keep their autonomy, or at least the illusion of it.
DeleteI agee with the fact that the doctors getting to watch themselves interact with their patients was very interesting. I think that this provides the doctos with the opprotunity to see how well they interact with their patient adn speak with their patients with this very complex subject. I think watching yourself interact on video allows the docotrsto see what they are doing right and wrong when speaking with patients. They are then able to modify their behavior and tweak their way of interacting to a way that is more repsectful and compassinate and professional. I am sure that many of the doctos would agree that watching themself on video helped them to become better at communicating with their patietns.
DeleteAfter watching the "Being Mortal" video, my eyes were opened. The video was very sad and depressing. After each interview with a patient, they said they said they had died two days later after the interview. I was surprised about how personal the doctor was when he interviewed the patients. I was taken back when the narrator doctor spoke with the female neuro-oncologist about how she tells people their dying and their options. She was very kind to the people in need of comfort during the challenging times and facing death. Personally, I thought this video was more depressing than the first video we watched at the beginning of the semester.
ReplyDeleteI agree with you lauren that the neuro-oncologist tells people about their illness she is graceful. She knows when to be silent and help the patient achieve and realize how they want to die weather at home or in the hospital. I disagree i felt the other video was more depressing because these people were able to die at home and live out their wishes if they wanted that where the other video the people die in the ICU and hospitals.
DeleteThis movie was definitely hard to watch at times. I was surprised with how personal the doctors were as well. When I started to think of why they did this though it made more sense. These are some of the last people that people may see before they die. They want to be able to leave them with a good impression. This may be a weird way to think about it but in reality it isn't. There is nothing that we can do about people eventually going to do. We need to teach people on how to be accepting of this. I think that the relationship that was given off is beginning to do so.
DeleteI agree, Lauren. This video was very difficult to watch at times, and I can only imagine what the patient's and their families had to go through. The neuro-oncologist was very kind and gentle when telling patients they would not have much longer to live. But, like the neuro-oncologist said, brain cancer has a very high mortality rate, so she had probably gone through similar episodes with many other patients, unfortunately.
DeleteI think that in the video "Being Mortal" the physician- patient relationship was more of a friendship then any thing else. I think this is due to the serious nature of patient's illnesses. I think anytime a patient is diagnosed with terminal cancer, the physicians have exhausted all possibilities and now the conversation turns to comfort measures and what we can we do fulfill your last wishes. In order to have these conversations you need to really know the patient and the family. They have put a lot of trust into your abilities and assuming you have been there from day one, the physician becomes more of friend rather than a consulting doctor. I think when some has a terminal cancer, they trust the physician like they would trust their best friend. Things become more personal when you talk about death and dying wishes.
ReplyDeleteI agree with this. I think the main reason why these relationships are more friendship based is because of the seriousness of the illnesses. It is almost impossible to be completely serious about this situation. I think these doctors feel the burden of having to be some type of emotional support for the patients and their families.
DeleteDefinitely. It is very important for physicians to be personable, honest and easy to talk to in these circumstances. In some situations, the physician is the only friend a patient has at the end of their life. Although most people have at least one family member or friend to fight the battle with, some people do not have anyone. In these cases, the physician needs to provide comfort for their patient on more than a physical level.
DeleteTori,
DeleteWhile i do agree with you that in this branch of medicine physicians need to provide comfort to the patient on more than just a physical level, i think this can be accomplished wothout being the traditional friend. Health care professionals have to maintain a level of professionalism, else the line of medicine can be blurred. The point of being a health care professional is to provode professional medical care. I think that this can be accomplished while still being a compassionate doctor. Even in nursing, he nurses who care for patients can be caring and comassionate and provide emotional care for the patient without being a 'friend' and maintaining pofessionalism.
I don't think that the traditional friend is the approach that we are talking about. I think its more a person to confide in and find comfort in. This is the role of a friend. They do need to keep a level of professionalism and i think that this can be accomplished while still managing to be that friend that the patient needs.
DeleteAfter watching this video, I believe the patient-physician relationship was that of friendship. All of these cases had a high level of intimacy because each case was very personal. These physicians gave out options as bluntly as possible but also informed the patient that they were there for them, they wanted what was in their best interest, they even openly talked about what the patient wanted and tried to do what was best for them. Very eye opening video, especially for someone going into the medical field.
ReplyDeleteAmanda, I did not consider those aspects of the physician-patient relationship as friendship but i do agree with the fact that these relationships have a high level of intimacy that i did not considered as being apart of a friendship. Excellent point. It was a very eye opening video.
DeleteI agree with this as well Amanda. They were blunt about the way they told their patients, however, they were there for a little emotional support. These doctors know they are giving horrible news and sometimes that emotional support helps to "lessen the blow".
DeleteAmanda, I agree with you that the physician - patient relationship is a friendship. I think when you are living with a life-limiting disease or cancer, you depend on the physician to be your friend and offer their opinion and be supportive of your decisions.
DeleteI thik that the most interesting thing about this video was that I got to see the doctor's side. When we watched the frontline video "Facing Death", we were shown the patient's perspective. I think it was very intersting to see the doctor's perspective and see how they handled themselves. I think it was very eye opening to see the doctor's side becasue I think that a lot of poeple so not consider what goes on from the physician side. I also found it intersting that the doctor's got so invested with their patient's. Not to the point to where they were unprofessional, but more invested than what maybe other docotrs in dofferent branches of medicine would. For this reason, i would have to say that the model was more of a partnership. The doctors were close with their patients, but they never lost their professionalism. They remained the medical professional, but had a deep compassion for theri patietns and allowed the patietn to be autonomous. I think that in a partnership, the persons invovled can be close, but they still retain that professional aspect that makes a partnership. Each person involved (doctor and patient) were able to keep their autonomy. I think that sometimes in friendship, their is no professionalism, only perosnal relationships. Frienship cannot work in the medical profession because docotrs cannot lose their professioalism. Therefore, i think that becasue the doctors were close with their patients, but still remained professional the model uses was a partnership.
ReplyDeleteI agree with you when you say that the model that was mostly used was a partnership. I think that because professionalism plays such a huge role in the medical field that it limits how much friendship can actually be within that particular relationship between physician and patient. I did also notice that both parties were able to keep their autonomy and this is one part of the video segment that I found intriguing.
DeleteWhen watching the "Being Mortal" I saw the patient-physician relationships being more friendship based than anything else. When the doctor talks about the women that was dying of cancer in the first interview the doctor mentioned "he wasn't ready to tell her that her lung cancer was getting worse and was taking her life". This is a prime example of a more friendship based patient-physician relationship. Another example is the doctor saying this experimental treatment was something that may treat her thyroid cancer as well as her lung cancer. He later admits in his interview with the patients husband that he misspoke and he wish he could take that back. He said he was running more on emotion at that point and wanted her to hope for the best. This statement also helps to show my point that the relationship is more friendship based. I think the video is very eye opening on how the real world works as far as life or death treatments and how doctors address their patients about it.
ReplyDeleteI think that the most widely used models based off the reading of Childress and Siegler are the Partnership model, the Paternalism model, and coming in at a distant third place, the Friendship model. The reason why I think that the Partnership model is the most widely used of the three is because, based off of the video, both parties are almost always searching for the best quality of life based on the time that the patient has left. In my opinion, the doctors in this video have shown that they are very willing to provide the best care that they can in whatever case may arise. I loved how the doctors acknowledged that they were being almost too optimistic about certain dire situations. But I think that we can all agree that most doctors do try and create a kind of partnership between the patient and the doctor themselves. Coming in second place, the Paternalism model is the next most widely used from the five models discussed by Childress and Siegler. I believe that this model should be modified, however. Instead of the patient being considered a child, I think we could make the argument that the patient should be treated like the willing and able teenage son or daughter, and that the physician be the caring and understanding parent. With this differentiation I think that there are many more cases played out like this across America. I think that sometimes, not always, but sometimes the patient just wants to be told what's best for them and what they should do. Finally, I chose Friendship as the distant third model because I know that sometimes doctors do get attached to their patients. This can call for a slight friendship, but a friendship none-the-less. I think that the Friendship model is definitely the least used of the three defined here.
ReplyDeleteIn my opinion, I think that the Partnership model/metaphor has the most benefits for the inflicted party. So no, I do not think that another model or metaphor should be used here. I believe that America has a decent, at least above average, system for dealing with end-of-life care. The Partnership model makes so much sense to try and orchestrate into the form of care given when one only has a limited amount of time left on this Earth. This model is empowering to the inflicted party, and the Physician is able to provide the best care he/she can based off of the wants and needs of the patient. This, to me, definitely seems like the absolute best option for end-of-life care.
I had never considered the modification the the Paternalism model. Not a bad idea.
DeleteI also had not considered modifying the Paternalism model. That is a very good way of looking at the types of relationships that physicians and patients build when it comes to terminal illnesses. While no adult wants to be treated like a child or given no say in their healthcare decisions, some might want to be treated like a teenager - bridged between autonomy and still relying on the input of those "above" them who care about them. Interesting!
DeleteI had never thought of the paternalism model because i thought the patient was not being treated as a child. However, I think that with your modified version of paternalism, this model is very relevant and works for this articular video. Great point!
DeleteI'd have to agree with the three above comments and say I never thought of paternalism. I agree with Tonya that I saw paternalism as the patient being treated as a child. With your modified version though, it fits this documentary very well.
DeleteI don't want to sound like a broken record, but I also had not viewed paternalism in that way. I think that paternalism is viewed as completely negative because the first thought that comes to my mind is a person being told what to do regardless of their wishes. However, like you said, some patients feel that they are incapable of making medical decisions so they feel more comfortable listening to what an educated doctor believes is the best approach to their situation. I don't think that this is necessarily wrong at all, I just think that paternalism often gives of an extreme negative dictation and that is not always the case.
DeleteThis comment has been removed by the author.
ReplyDeleteI am having trouble determining whether the relationship seen between the patients and doctors in this documentary was a Partnership or a Friendship.
ReplyDeleteI feel that the Partnership relationship better fits both of relationships seen in this video due to the fact that the majority of the communication that I saw take place between the doctor and their patient went along the lines of the patient telling the doctor how they were doing and what treatment they would like to try, and then the doctor giving them his/her opinion. There was really no "intimate" connection that I would have expected in a Friendship relationship. The only time I saw anything close to a Friendship relationship was when the female doctor finally worked up to telling her patient that he wouldn't survive his cancer and she hugged him at the end of the meeting.
I feel that this relationship does not describe most end-of-life care that we see today, however my experience is sadly lacking in this area. While I think a Partnership would be better suited for situations like this, I believe the reason why we do not see it is due to the fact that often times the patient is incapable of making a decision for themselves and their family is in turmoil over making any sort of decision that could ultimately result in ending a loved one's life. Because of this turmoil, I believe the relationships that we see most often are the Paternalistic or Contract relationships.
I can see where you're coming from with the difficulty deciding whether there was a partnership or friendship in this documentary. However, do you think it could be both? Not all doctors are the same, therefore some doctors may for a partnership or friendship with patients and I believe that is what this documentary is doing.
DeleteAdding on to what Emily said, I also believe that not all doctors are the same (obviously), but I know that some doctors may actually prefer to distance themselves from their patients so they don't get too attached. This attachment could lead to a Friendship relationship and that is often times not the goal of the physician. But, in regards to end-of-life care today, I agree with you about the Partnership model being a better fit for the situation. I think it's interesting that you brought up the fact that no one wants to see a loved one go, and I think that the "turmoil" caused in the family is significant enough to, unfortunately, void the Partnership model altogether (sometimes).
DeleteI think in the documentary the relationships between the physicians and the patients is partnership and friendship. I believe the relationships were a friendship because of the emotions put into their relationship. Both the patient and physician seemed very close and to value the opinion of each other. The physician in the first scenario stated about the physician telling the husband of his patient that he had lied to them about an option because he (the physician) wasn't ready to give up fighting, had been running on a lot of emotion and didn't want to give up hope. The physician does regret his choice of lying and wishes he had never said anything about it. The partnership relationship is the major component in each physician-patient relationship. The patient and the physician worked together as to what their next step would be. The physician gave the options they could take and explain which they thought would be best but gave the final decision to the patient. The physicians in each encounter were respectable to the patients autonomy. They were professional and emotional which I think helped them through talking with the patients about their death.
ReplyDeleteI think that in America if the patients are able to communicate with their physician then most of the relationships are partnership. I think that this model is very effective at accomplishing what should be done. The physician can explain and talk to the patient in a regard that helps them understand and come to terms with their death. It can help the physician and the patient learn what needs to be done and how they can accomplish it in a way the patient is most comfortable. For example, in the documentary two of the patients wanted to die at home and the physicians did everything they could to be able to do that for them. Another patient wanted to travel to Disney World with her granddaughter before her death, this was not able to happen because her disease had worsened and ever required her to stay in the hospital to receive the treatment needed.
I have to agree with the consensus that the physician-patient relationships modeled in "Being Mortal" follow the partnership model, leaning towards friendship. I can't think of anyone who, in the last stretch of their life, would want to be treated by a physician as anything other than a partner or friend. If I were to be diagnosed with an illness that was deemed terminal, I would want to have support and comfort from the physician overseeing my treatment. Knowing that the physician cared about me as an individual and wanted the best for me would put my mind at ease, because I would be assured that I was being given the best care that the physician could provide for me. Death is never easy, especially if it comes too early and by a terminal illness. Physicians sit in a spot where they have the ability to make the transition from life to death a bit easier (in a sense) for their patients.
ReplyDeleteI agree Tory. If I was put in the situation where I had a terminal illness, I would want the physician to be my friend and guide me through the scare roads ahead. I think that it is important to have someone to lean one and give the best advise possible.
DeleteAlthough I think a physician being your "friend" might cross of the boundary of the professional relationship especially when dealing with the end of life, I definitely agree that this needs to be more of a partnership. I think it goes back to what true informed consent should be about which is an ethical imperative and shared decision making between the provider and patient. This would only lead to more comfort, support, and ease of mind in an often very stressful time.
DeleteAustin, I agree that the boundary of professionalism can become easy to cross in these situations. Though, I do think it is possible to maintain professionalism while being attentive to patients and letting them know that you care about them as an individual. I like your comment about informed consent.
DeleteI definitely agree that the models used in the video were a combination of partnership and friendship. In the partnership model, collegiality, collaboration, association, co-adventureship, and covenant is used. The friendship partnership consists of the patient expressing trust and confidence in the physician while the doctors "friendship for the patient should consist above all in a desire to give effective technical help-benevolence conceived and realized in technical terms." For each of the patient's seen throughout the video, each one had these kind of relationships with their doctors. You could tell that the doctors genuinely did care about their patient's, and they did not like telling them any bad news when they had to. I think that most end-of-life care is a combination of these two models. Doctors want the best for their patients, and are normally just as disappointed and sad when a treatment does not work for an individual. I also do not think that these models need to change.
ReplyDeletei agree that it was very evident the genuine care that the doctors had for their patietns. I think it would be very hard not to get invested in the patient's lives because they are seen on such a regular basis and things are just at a much higher emotional level. I agree that these models are the best for end of life care and they do not need to change. I think that the combination these two modles work the best in these tyoes of situations. I donot think any other model or any other combination of the models would work as well as partnership and friendship.
DeleteIn the video the partnership between the physician and the patient was that of a friendship. The physician really tried to understand the patients feelings and tried to honor the patients wishes to the best of their abilities. The way the physician broke the news to the patients was very interesting in that they would bring up both the best and worse scenario so that they could get the patient to start thinking about the worst scenario while still allowing for hope for the best outcome. Eventually, in the video, the patient would come to the realization on their own that they were going to die. This made it easier on the patient to accept their own death and appreciate the life that they had lived and the short life that they had left.
ReplyDeleteThis is all very true, but I think that there was also a partnership aspect in these relationships as well. As partners, they collaborated and worked together to decide on the best mode of treatment for themselves/their patient. I think that the combination of these two models works out very well for both patient and physician.
DeleteI agree that there was definitely a partnership between the patient and the doctor. They worked together and stressed their opinions about certain treatments. I think that this collaboration works well for both the patient and doctor as well.
DeleteThis video really opened my eyes to the friendship that was between the patient and the Doctor. The ability of the doctor to understand and be able to sympathize with the patient was something that is really hard for some doctors. It's hard to think about bad scenarios in hard situations. The doctors seemed to break the news in a way that wasn't too hard and very easy for the patient to understand. The patients seemed to feel more at ease and understand of their death from the ability to be soothed from the doctors. The patient's seemed to understand the doctors were doing the best that they could to treat them and that if things didn't work out they were just as upset.
ReplyDeleteI saw friendship and partnership between doctors and patients. This video showed me how difficult it can be for doctors. They feel sorrow in the inability to help their patients. You can clearly see the doctors and patients working together to decide the best course of treatment, or the agreement to stop treatment. As friends, doctors sympathize with patients.
ReplyDeleteThe relationship between the physician and their patients was more of a friendship but also a partnership which I think is okay. However, I think physicians would have been more honest about their patient's potential outcome if it was more of a partnership. For example, the oncologist for the man with the brain tumor enrolled him in an experimental trial to give him some hope although she knew it most likely was not going to work. I feel that she did this to give him hope, as a friend, but it only made him suffer more when he could have been enjoying his last couple of days not in pain.
ReplyDeleteIn my opinion, the role of medicine is to help patients. Helping does not necessarily mean curing or treating however. If a patient is at the end of their life, they should receive spiritual and emotional help. People often forget that their are other aspects to health than just physical health. I believe this can be fixed with more open conversations about death perhaps with palliative care physicians and patients should also make the decisions about what happens when this time comes.
A positive message I received from this video is that, a person's last days do not have to be spent in a hospital, possibly suffering. This is most often what we assume when we think of someone dying. So it was nice to see what people enjoyed their last days in comfort.
DeleteGabrielle, I believe that you are absolutely right on the role of medicine. I think it's great that you brought up that helping doesn't always mean curing because I think that is often overlooked, even by myself. End of life should be seen as a time for a patient to receive that emotional and spiritual help because I think it eases their suffering and ultimately their death. I agree that you cannot fix death and the fact that someone is going to die, but you can fix it so that a person dies peacefully instead of suffering.
DeleteThere is a clear view of partnership happening between the doctors and patients in this documentary. They were constantly collaborating together on where to go from the situations the patients were presented with and each doctor respected the patients autonomy. I do believe that there was also a little bit of friendship seen especially with the female doctor and her patient with brain cancer. As Kant suggests in the reading, friendship consists of both paternalism and anti-paternalism. In the video, the doctor clearly shows her love and care for her patient, but she still maintains respect for the patients autonomy and equality. The man even stated later on that he did not want to have to hear her try to tell him nicely that he was at the end of his road anymore because it hurts both the doctor to say it and him to hear it.
ReplyDeleteI think that most physician-patient relationships in America today consist of partnership, at least from my experiences and what I have seen. When my grandfather was diagnosed with pancreatic cancer, he had a great doctor who knew what to say, when to say it, and the best way to say it. He provided different possibilities and ways to go but expressed what he believed was the best option. He respected every one of my grandfathers wishes and his autonomy, especially in the last few weeks of his life. I think that partnership is the best relationship to have with a physician. While I do think that a little bit of friendship is beneficial, I believe too much of it could make a patient suffer more than they already are. I would want my physician to care for me and to see me more as a friend than just a patient they are helping, but I would not want their judgment to be clouded by friendship.
After watching the video it is obvious to see that the doctor and the patient have to constantly work together and have to communicate about everything. I personally think that this would be a great relationship to have with your doctor. I loved how in the video the doctor would try their best to put themselves in the patients shoes and respect their feelings on the situation. I think that since they have this relationship with their doctor it made receiving the news of not having much longer a lot easier, because the patients knew that the doctor paid full attention to them the whole process, and allowed them to realize they had tried their best.
ReplyDelete