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Inside the Real World of End-of-Life Care

End-of-life specialists are 'psychoanalysts,' 'detectives'

By Matt Cantor,  Newser Staff

Posted Aug 20, 2009 5:49 PM CDT

(Newser) – With so many up in arms about “death panel” rumors, the New York Times paints a picture of real-life palliative care providers, or end-of-life consultants. The Times follows one specialist in a field that requires its doctors to be “part psychoanalyst, part detective,” writes Anemona Hartocollis: He’s fine-tuned to take cues from patients as to how to provide the most comfortable last days possible—by discussing everything from what gives them strength (shopping, said one woman) to where they want to die.

Palliative care is a far cry from a death panel, Hartocollis learned in her yearlong observation of the field. “Their intention was not to limit people’s choices or speed them toward death.” Instead, while consulting on moral and physical questions and speaking with patients’ families, “they were more subtle, cunning and caring than their own words sometimes suggested.” Hartocollis focuses on the specialist’s four-month interaction with one cancer-stricken woman: Contrary to what you might expect, he never tells her she’s going to die. “Patients sometimes will be very explicit about wanting that information very, very clearly delivered,” he said. “Whereas other people don’t.”

Being a palliative specialist can take both cunning and caring.
Being a palliative specialist can take both "cunning" and "caring."   (Shutterstock)
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COMMENTS
Showing 3 of 16 comments
riffran
Aug 21, 2009 10:55 AM CDT
all I can say is....AMEN BROTHER
oldgoat
Aug 21, 2009 9:44 AM CDT
My Mom was on hospice and they did a great job, but it is just as much if not more important that people can get a chance to talk about things they need to consider in their later days while they are still lucid enough to do so. Also any family members should be there so that they know what the person is wanting and so that they also understand some of the things that need to be done sooner than later like power of attorney and living wills.
riffran
Aug 21, 2009 8:35 AM CDT
Hospice is a great organization, I wish more people in the terminal end of a disease process would utilize it more. It help the family and loved one cope with what IS going to happen, not with the what if...so to speak.... But I do feel that if the government got into it , it would be a nightmare. Home health is a good example. It got way out of control, and unscrupulous people were financially raping the system. The government stepped in to "fix" the problem, now the documentation is so onerous and anal to the point of stupidity, and dysfunction. When you have to spend more time documenting what you did for the patient, than you spend actually caring for the patient there is a problem. example...pain control. you have to document that the patient has pain, and quantify it..then you document if you gave meds for the pain, or tried other comfort measures. Then you have to go back in about 30 minutes or so and document if the measures were effective or not and re-assess the pain level, then document if there were any adverse reaction to the meds or if there were not any adverse effects, then you have to document that you have addressed these issues on the care plan, and if there is any problems you document what you have done to address it, such as notify the MD, who you notified, when notified any orders received, and if you did get an order And you give something guess what? You start the whole process over again....Imagine that with 4 to 10 patients!.....THATS what I am afraid of...THAT getting worse than it already is . I have yet to see a governmet controlled area that wasn't rife with red tape

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