Read our newest publication in the CMAJ


Deathless models of aging: Time to reform CanMEDS

CMAJ October 15, 2013 Vol 185(15):1347-8.

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Don’t Euthanate, PALLIATE !!!


It is no wonder so many terminally ill patients are begging for euthanasia. The vast majority of terminally ill patients are seldom offered a “purely palliative approach” (comfort measures only).  Instead, patients are being paternalistically forced to adopt futile medical micromanagement until their last breath. Where is the patient-centeredness in this equation? While dying patients are getting their hemoglobins, serum potassiums, and serum rhubarbs treated, there is negligible regard for the suffering they are experiencing. Available research shows NO survival benefit in continuing Active/Aggressive Medical Micromanagement (AAMM) over a purely palliative approach in late stage patients (PPS<50%). All the “fluffing and buffing” of such patients is not in the best interest of the patient, families or the health care system. Unfortunately, most physicians find it easier to simply continue with futile “fluffing and buffing” instead of having  fulsome discussions about natural history of disease, prognosis, and effectiveness/efficacy and burden of those AAMM treatments. It behooves physicians to thoroughly discuss these foundational issues with patients in order to allow them to choose the direction/philosophy of care that is consistent with their own preferences, values, beliefs, and wishes. Available research shows that if such patients are given a choice, the majority would choose a purely palliative approach (comfort measures only), while withholding continued AAMM. Such a truly patient-centered approach will lead to fewer requests for euthanasia.

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Early adoption of Palliative Care, NOT Euthanasia, is the way to achieve “Dying with Dignity”


It is no wonder so many terminally ill patients are begging for euthanasia. The vast majority of terminally ill patients are not even offered a “purely palliative approach” (comfort measures only) and are forced to adopt futile medical micromanagement until their last breath. Where is the patient-centeredness in this equation? While dying patients are getting their hemoglobins, serum potassiums, and serum rhubarbs treated, there is little regard for the suffering they are experiencing. All the “fluffing and buffing” of such patients is not in the best interest of the patient, but only in the interest of the physicians.

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Deathless models of aging


Read my most recent publication in the CMAJ on “Deathless models of aging: Time to reform CanMEDS”

 

http://www.cmaj.ca/content/185/9/751/reply#cmaj_el_716380

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WOUNDS – The Hidden Epidemic !!!


Check out the March edition of Current Opinion in Supportive & Palliative Care for a comprehensive series of articles on Wound Management that I was invited to edit.

Patients with advanced illness represent the cohort within healthcare with the highest prevalence and incidence of all wound classes.

http://journals.lww.com/co-supportiveandpalliativecare/Fulltext/2013/03000/Editorial_introductions.1.aspx

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Lessons from El Salvador – Humane Medicine 101


I’m presently volunteering at an orphanage for disabled children within the mountains of El Salvador. I’m part of a benevolent Italian-Canadian RC church group from the greater Toronto area. This orphanage has continued to flourish largely to the dedication and leadership by our pastor, Father John Borean.

As I prepared for this experience I thought in terms of offering whatever help I could (child care, maintenance, construction etc) as well as potentially offering my expertise in wound management. Upon arrival, I quickly realized that I could not practice my professional in the classic “high tech” mode that I was accustomed to in North America. However, I  began to see that the absence of “high tech” was more than offset by he enormous levels of “high touch” (love) extended to the over 120 children by their staff caregivers, nuns, volunteers, and healthcare professionals.

As I reflect on the contrasts between healthcare (medical care) in developed countries versus that occuring in developing countries, I must emphatically conclude that a truly humane approach no longer occurs in developed countries. It is a rather de-humanized approach that focuses on the disease rather than focussing on the whole patient. In this system, there is very little interaction between physician and patient as all of the attention relates to the micro aspects of the disease rather than the effect that it is having on the patient as a whole. Moreover, this had led to the development of physicians that are boldly paternalistic and egotistical, while painfully lacking humility and compassion. Thus, physicians from developed countries have lost their skills in the art of medicine which is the essence of a truly humane approach to healthcare (medical care).

I was fortunate to be mentored by a couple of eminent professors from the University of Toronto, Dr. DG Oreopoulos, and Dr. WO McCormick. I regard both as icons and trail-blazers. Both have been pivotal in my own personal and professional development. In 1983, Dr. Oreopoulos published a manuscript in the CMAJ in which he made a passionate plea to restore “Humane Medicine”. In this paper, he quotes M. Balint (1964) who originally stated “the most potent medicine that a physician has to prescribe is “himself”. During the late 1970’s, Dr. McCormick coined the term “Humbility” to desribe the key elements for the synthesis of the ideal physician, namely, humility and ability.

In summary, my experiences in El Salvador have reminded me that we need to not only practice in a manner that espouses the principles of “patient-centered care”, “interprofessional collaboration”, “integrative healthcare”, and “evidence-based medicine”, but, also restore a more HUMANE approach in which we connect with the “whole person”  through the extension of humility, compassion, and love.

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Check out the March 2013-Current Opinion In Supportive & Palliative Care


I edited the special edition on Wound Management in Patients with Advanced Illness.

http://journals.lww.com/co-supportiveandpalliativecare/Fulltext/2013/03000/Editorial_introductions.1.aspx

Posted in Palliative Medicine, Wound Management | Leave a comment