A Different Perspective on the End-of-Life Discussion

Today I attended a training that was being put on by the fellows for the residents on how to discuss advanced directives. This comes up a lot during internship for me and it is relevant to the work I want to do in the future so I was intrigued to get a different take on having the conversation. It was really interesting, after discussing some of the basics (DNR, Five Wishes etc) the residents broke into groups and conducted roles plays to practice having the conversation with patients.

Watching the doctors do role plays was way different than my experience with role plays in social work. I think it was a good learning experience for all of us though. The last vignette was not the ideal situation in terms of advance care planning. Ideally I think the idea is to start having this conversation with patients and caregivers while the patient is in good health before a crisis. This way everything is in order and everyone is on the same page in the event of a medical emergency or just general decline. The last vignette I think was maybe a bit more realistic though because unfortunately sometimes advance care plans are not made before but rather during a crisis.

In this role play the patient was being told that the cancer they had been receiving treatment for had metastasized and that their oncologist had made the determination that the patient was terminal. In this scenario the patient did not seem to grasp the prognosis and was wanting to do everything possible, even things that were not medically possible, in order to get better.

I have never seen a doctor diagnose a patient as terminal, I have seen a patient receive bad news though and it can be heart breaking. The “doctor” in this role play was a medical student so (although I do not know this for sure) I am willing to bet that she probably has not had to have this conversation with a patient yet. I was really impressed with how she handled the situation. I have no idea what this is supposed to look like, I have no clue if the other doctors present thought she did well or not, but I thought she showed great empathy while relaying the information in a direct way and in concrete terms in order to avoid confusion. From there she discussed end of life planning which again I thought she did beautifully.

It must be so difficult to be the one responsible for delivering life changing news like that, it gave me a lot of compassion for what that must feel like for doctors in that position.

Today’s training gave me a new perspective on material I am already familiar with, I am glad I was able to participate.

In other news I just rsvp’d for the NASW social work month celebration event that is going on at the end of the month. I have no clue what to expect but I am sure it will be nice. I am hoping some of my friends from the program will be going so I will have a chance to catch up with them. This is such a busy semester for all of us though that I am not going to hold my breath.

Tomorrow my supervisor, myself, and my colleague from the program are meeting with another local agency to learn more about their services. This is an important meeting because we refer a lot of clients to this agency and I do not fully understand how they work so I am excited to learn more what they do.

 

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