User:Badgettrg/death

This text is proposed to go into the death article to detail the experience from the physician's perspective. Please comment at User_talk:Badgettrg whether this seems appropriate.

The Physician's Perspective

A qualitative survey of internal medicine doctors in the United States found three sources of satisfaction from medical practice:

1. realizing a fundamental change in perspective via an experience with a patient
2. connecting with patients
3. making a difference made in someone's life

The authors of the survey noted how often the meaningful events, such as connecting with patients, occurred at events, such as death, that normally suggest a failure of medical care . The following research suggests factors associated with a meaningful death.

A qualitative study using focus groups that consisted of "physicians, nurses, social workers, chaplains, hospice volunteers, patients, and recently bereaved family members". The groups identified the following themes associated with a 'good death'. The article is freely available and provides much more detail.

1. Pain and Symptom Management. Patients want reassurance that symptoms, such as pain or shortness of breath that may occur at death, will be well treated.
2. Clear Decision Making. According to the study, 'participants stated that fear of pain and inadequate symptom management could be reduced through communication and clear decision making with physicians. Patients felt empowered by participating in treatment decisions'.
3. Preparation for Death. Patients usually wanted to know what to expect near death and wanted to be able to plan for the events that would follow death.
4. Completion. Completion includes not only faith issues but also life review, resolving conflicts, spending time with family and friends, and saying good-bye.
5. Contributing to Others. Allowing terminally ill persons to contribute to the well-being of others. One family member said, "I guess it was really poignant for me when a nurse or new resident came into his room, and the first thing he'd say would be, ‘Take care of your wife’ or ‘Take care of your husband. Spend time with your children.’ He wanted to make sure he imparted that there's a purpose for life."
6. Affirmation of the Whole Person. They didn't come in and say, "I'm Doctor so and so." There wasn't any kind of separation or aloofness. They would sit right on his bed, hold his hand, talk about their families, his family, golf, and sports.
7. Distinctions in Perspectives of a Good Death

In an essay, 'On Saying Goodbye: Acknowledging the End of the Patient–Physician Relationship with Patients Who Are Near Death' suggestions are made to health care providers for saying good-bye to patients near death. . The quotes below are from the article. The article is freely available and provides much more detail.

1. Choose an Appropriate Time and Place
2. Acknowledge the End of Your Routine Contact and the Uncertainty about Future Contact The doctor could say, "You know, I'm not sure if we will see each other again in person, so while we are with each other now I want to say something about our relationship."
3. Invite the Patient To Respond, and Use That Response as a Piece of Data about the Patient's State of Mind The authors suggest saying "Would that be okay?" or "how would you feel about that?"
4. Frame the Goodbye as an Appreciation The authors suggest examples such as "I just wanted to say how much I've enjoyed you and how much I've appreciated your flexibility [or cooperation, good spirits, courage, honesty, directness, collaboration] and your good humor [or your insights, thoughtfulness, love for your family]."
5. Give Space for the Patient to Reciprocate, and Respond Empathically to the Patient's Emotion If the patients becomes tearful, the doctor can provide silence to allow the patient to respond, or the doctor may ask something what the patient is feeling.
6. Articulate an Ongoing Commitment to the Patient's Care Do not make the patient feel abandoned, "Of course you know I remain available to you and that you can still call me".
7. Later, Reflect on Your Work with This Patient

Other difficult issues for physicians include providing sedation for a patient at death and discontinuing life support. The following case reports detail these experiences .