Stellar End-of-Life Care at the VA

VA imageIn observing for the book I am writing about the VA healthcare system I have been observing the most stellar end of life care given by the palliative care and hospice team at the San Francisco VA.  They are doing amazing things in reaching out to physicians to educate them about pain and symptom management for patients with chronic and terminal illness (as Nurse Practitioner Patrice Villars, writes , see A Rant on Terminology: we have to try to find another word for terminal don’t we?).  They are also trying to help physicians slow down the pressure they all too often place on patients so they can help veterans and their families  make more thoughtful decisions about their goals and needs when they are reaching the end of their lives.  I have spent the last two weeks watching physicians, nurse practitioners, social workers, bedside nurses, psychologists, chaplains and a host of others meet with patients and skillfully and graciously talk with them about some of the most difficult issues human beings ever face. In the process, they are also educating residents, interns, nurse practitioner and social work students, oncologists, ICU … Continue reading

 This post on Terminology in Medicine, which follows on the post I did on failure yesterday is from the wonderful blog GeriPal. on Geriatrics and Palliative Care, which we need a whole lot more of.  It’s by Patrice Villars who works in Palliative Care at the VA San Francisco.  I have been following Patrice and her colleagues Eric Widera and Barb Drye and others on their team for a new book I am writing on VA healthcare.  They are amazing!!!  You can find their blog at at Thursday, August 27, 2009

A Rant on Terminology

News Headlines read: Sen. Edward Kennedy loses battle with cancer. Really, he lost? I thought he died from a malignant brain tumor, an “aggressive” brain tumor. The median survival is less than a year for people for his particular tumor. Kennedy was diagnosed in May of 2008. He lived over 15 months after diagnosis. What a loser. He must not have fought hard enough. Huh? I thought he spent most of his life battling for social and health care reform in America. (See Chrissy Kistler’s tribute to Senator Kennedy.)

How … Continue reading

Let’s Change the Language of Medicine and Get Rid of the Blame-Shame Lexicon

blame game imagesContemporary medicine is obsessed with failure. Look anywhere, or everywhere and the word “fail” keeps cropping up. The word is almost always associated with personal blame and thus with personal shame. Physicians, for example, worry that they will “fail” to correctly diagnose an illness and be punished for this failure. Pediatric residents worry that they will “fail” to insert an IV into a baby with tiny veins and thus have to call on surgeons (who will, behind their backs snigger at their “failure” to insert the IV and their need to ask surgery for help) to help. Think of some mistake that physicians – who do not escape the human condition when they graduate medical school — could make and you can bet that the word failure is attached to it. Amazingly (given the fact that there is no reported example of a human being making it out of this life alive) physicians are socialized to consider that they have personally “failed” if a patient dies (not only from a medical mistake but from the inevitable fact that some diseases can’t be cured, or even well managed and that death … Continue reading

Wonderful Article on Interprofessional Care

I just want to post this article on genuine interprofessional care that just appeared in Academic Medicine.    It focuses on what the VA is doing to create new models of real interprofessional care.

AM Rounds

From Interprofessionalism Lite to the Real Thing

Featured, Guest Perspective January 15th, 2015

health care team

By: Jessica Early, a nurse practitioner fellow at the West Haven Veterans Affairs Center of Excellence in Primary Care Education (CoEPCE)

During my time in nursing school, the constant refrain was that interprofessional teamwork is the foundation of patient-centered care. In lectures and seminars, we were told that, as nurse practitioners (NPs), our effectiveness depended on collaboration with all members of the health care team—social workers, RNs, physicians, and specialty providers. Ironically, we were encouraged to develop the communication and teamwork skills needed for this collaboration in a classroom full of nursing students, led by a nurse faculty member, in a building only serving students pursuing a nursing degree.

In my three years of school, I had … Continue reading

Just Published New Book Collaborative Caring

CollaborativeCaringI am very happy to announce that I, along with my two co-editors, David L. Feldman M.D. and Michael Leonard, M.D. have just published our edited volume Collaborative Caring: Stories and Reflections on Teamwork in Healthcare.  The book is a collection of 50 rubber-hits-the road stories about what it means to implement teamwork, work on teams, or to work in settings in which there is no teamwork.  The wonderful people who contributed their essays include physicians, social workers, bedside registered nurses, psychologists,occupational and physical therapists, nurse practitioners, pharmacists, dentists, and hospital administrators.  The book also includes essays by healthcare professionals who write as patients who find themselves either the center of a team or exiled to the periphery when healthcare professionals function in siloed isolation. The book begins with an introduction (part of which is included below) and  is divided into eight sections, which cover the following topics:

Playing on a Real Team; The Dangers and Damage of Poor Teamwork; Is the Patient on the Team or Not; Psychological Safety; Teaching What We Preach; Patient Advocacy as a Team Sport; Barriers to Teamwork; Taking Teamwork Institution and System-wide.   The essays in … Continue reading