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rethinking palliative medicine

rethinking palliative medicine. gaurav mathur MD palliative medicine. Iatrogenesis. Any adverse effect (or complication) resulting from medical treatment. Iatrogenic causes:. medical error wrong prescription, perhaps due to illegible handwriting negligence

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rethinking palliative medicine

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  1. rethinking palliative medicine gaurav mathur MD palliative medicine

  2. Iatrogenesis Any adverse effect (or complication) resulting from medical treatment.

  3. Iatrogenic causes: medical error wrong prescription, perhaps due to illegible handwriting negligence faulty procedures, information, or methods failure in life support instruments prescription drug interaction adverse effects of prescription drugs nosocomial infection over-use of drugs leading to antibiotic resistance blood transfusion

  4. The ultimate cause of iatrogenesis Us.

  5. The ultimate cause of iatrogenesis (Physicians)

  6. Modern medicine is a tide • We like testing fluids: blood, urine, saliva, semen, stool, CSF, etc... • We like to biopsy, cut, excise, sever, debride, evacuate, and implant things. • We like to look through the body, but not at the body. (X-rays, CT, MRI, PET, U/S, etc.) • All these things lead to more tests, more procedures, more treatments, and more tests.

  7. Patients need to know about the tide. • Modern media dupes patients. • They don’t know that we often project more optimism than clinically appropriate. • The tide pulls them toward iatrogenesis.

  8. Iatrogenesis leads to: Iatrogenfarction

  9. Iatrogenfarction A series of iatrogenic events that causes suffering, compromises dignity, and - in some cases - hastens death.

  10. Patients suffer. Pain Dyspnea Nausea / vomiting Diarrhea /constip. Weakness Anorexia / cachexia Severe anxiety Terminal agitation Seizures PAIN

  11. Patients suffer. Helplessness Alienation from God Body dysmorphism Suicidal wishes Isolation Guilt Frustration Fear for themselves Fear for family

  12. Dignity is avoiding this:

  13. Mightier than the sword. Chemotherapy Radiation therapy Hemodialysis Broad spectrum antibiotics Intensive care unit Feeding tube Blood transfusion Major surgery Physicians generally underestimate the iatrogenic effect.

  14. Palliative care • Most people think that palliative care is for the patient about to die. • Most people don’t think of serious illness. • People generally avoid thinking about (or discussing) death.

  15. It’s not that I’m afraid of dying. I just don’t want to be there when it happens. -Woody Allen

  16. Rethinking palliation • Palliative medicine is not about death. • It’s about focusing on symptom control. • It’s about “going gently”. • Begin palliating when symptoms don’t respond to treatment of disease.

  17. Anyone can palliate • Listen • Touch • Be present • Ask about suffering • Treat pain. Treat the symptoms aggressively. • Get help.

  18. A public health issue Consider the following statement: “We should vaccinate every patient, because vaccinations reduce suffering. “The vaccination rate should be 100%”

  19. A public health crisis Now, consider this: “We should palliate every patient, because palliation reduces suffering. “The palliation rate should be 100%”

  20. Not even close Many physicians are not palliating symptoms. Most physicans are not consulting others to palliate. Many physicians are unaware of their patient’s suffering. As a result, most patients don’t receive palliative care until it’s too late. And some never receive it at all...

  21. An important point: Not every patient is the same. “I want to go gently...” “I’m gonna fight this..” Many patient won’t bring it up, or haven’t thought about it. Others are unrealistic

  22. But medicine is a tide... We assume that every patient is a fighter... “I want to go gently...” “I’m gonna fight this..” Even though we haven’t asked them.

  23. Solution: Ask.

  24. Asking empowers the patient.

  25. “I want you to tell me when the treatments become too burdensome.”

  26. “This treatment has hope of keeping you alive, but it could also have side effects. “

  27. “Some patients want to stay out of the hospital no matter what. Let me know if you ever feel that way.”

  28. “Remind me next time to tell you about palliative care.” “It’s just planning for if you ever get really sick.” “It’s routine.”

  29. Conclusion Iatrogenesis and iatrogenfarction are caused by physicians. Only physicians can prevent it. Prevention lies in informing your patients. Palliative care begins with you.

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