Doctors, nurses; do you want to die the way your patients die?

WHEN THE TIME COMES TO TELL OUR STORY, WHAT WILL WE SEE?

Continuing the Salzburg Questions series that encourages a global discussion about the key issues affecting palliative care.

Today, on International Right to Know Day (28 September) Dr Bruce Chernof, President and Chief Executive Officer of The SCAN Foundation, California, USA, explores the seventh question in the Salzburg Questions that asks: Doctors, nurses; do you want to die the way your patients die?

Dr Bruce Chernof

Around the world, healthcare providers are trained to be objective, rational, and clinical at the bedside. Long white coat, white dress, white smock, maybe a white hat – they are just signifiers, tropes, costumes in a performance, where we are the ‘good guys’ here to right wrongs and cure the sick. And of course, following the Hippocratic Oath: ‘First, do no harm.’ So this is what we do, day in, day out, with dedication and compassion, but always through that dispassionate clinical lens. Until . . .

When the tables are turned, and the provider is the patient, what seemed like an uplifting virtuous drama reads much more like a comedy, or worse, a tragedy. It is time for all healthcare providers to take a deep, introspective look at our practice. Are we caring for the whole person or simply going about the business of treating patients? Despite all of our progress to transform healthcare delivery to make it more holistic, it remains utterly biased toward the antiseptic and technical aspects of treating patients. Healthcare prioritises safety and cure above all else, yet in our own lives we are far more likely to prioritise autonomy, dignity, and happiness. We have an enormous number of technical measures to track the quality of medical services, yet almost no measures for quality of compassion or respect. All healthcare providers secretly pray for quality of life for ourselves, balanced with technical quality of care. So here is the little secret I have learned over three decades: all our patients want the exact same thing.

We need to break the bonds both of incrementalism and lofty strategic planning that seem to be the brick walls and iron bars that serve as our stage’s proscenium and backdrop. Endless, minute Plan-Do-Study-Act cycles, policy reforms for one more new payment code, or dramatic 10-year global targets may be part of the solution, but these are not the answer.

We need to commit to delivering care to every person and every family exactly as we would want to be treated. For as we all know, autonomy and dignity are not delivered through the sharp prick of an IV catheter or a light blue gown that doesn’t quite close completely at the back. When the time comes to tell our story, what will we see? Virtuous drama with an uplifting ending? Comedy of errors? Or simple tragedy? The choice is ours.

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