How Do You Help Your Patients to a Good Death?
SUKHIT PHAOSAVASDI, M.D.*, YUEN TANNIRANDORN, M.D.*, HENRY WILDE, M.D.*** CHUMSAK PRUKSAPONG, M.D.**, SURASAK TANEEPANICHSKUL, M.D.*,
Affiliation : *Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkom University, Bangkok 10330, **Department of Surgery, Police Hospital, Bangkok 10330, ***Queen Saovabha Memorial Institute, Thai Red Cross Society, Bangkok 10330, Thailand.
Caring for a patient with terminal disease is a chore, none of us, like yet all of us have to face. Many physicians elect to suppress facing the inevi- table and carry on intensive life support and "cura- tive" treatment ignoring the certainty of imminent death. This avoids the discomfort of having to dis- cuss prognosis with the patient. Patients, who are often aware of their state, usually will not ask ques- tions or express their wishes at this time. The doctor is uncomfortable to bring up the subject as well. It is also not uncommon that, at this point in history, some of the attending specialists are hard to find, make precursory very brief visits and communica- tion and care are largely left to nurses and an occa- sional "family doctor", if there ever was such a person on the case. This common chain of events leads to additional suffering, futile treatment and expenses that the family will have to bear. Yet it is not easy to communicate with the patient at this point. It requires true professionalism, humanity, tact, and honesty on the part of the attending doctor. The American College of Physicians (ACP) has been devoting considerable efforts to run seminars and discussion groups dealing with this issue. Physicians are now given guideposts on "end of life care" and are encouraged to teach their house officers and fellows how to deal with such patients. Here are some of these guidelines as presented by Dr. Donald M. Berwick at the recent Detroit annual session of the ACP:
Keywords : Ethics, Good Death
