Compassion & Humanism in Healthcare: The Lens of Language. Deborah Cook
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1 Compassion & Humanism in Healthcare: The Lens of Language Deborah Cook
2 Objective Acknowledging the pervasive suffering in the ICU.. To consider how stories may enhance humanism & foster compassion
3 Sympathy Empathy Compassion Clinician Ego-based Emotional Altruistic Response Attributes Verbal Reactive Verbal Affective Virtuous & Action-oriented Regarding Suffering Acknowledge Acknowledge understand & resonate Ameliorate Patient Response Pitied & Patronized Heard & validated Suffering Well-being Adapted from Sinclair et al, 2016
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5 Language is Dehumanizing Bed 3 The lady with sepsis That bad GI bleed The PRISMA guy She bought herself a tube
6 Stories Are Dehumanizing Scripted case histories Abbreviations Template notes Digital documentation E-handovers Silverman, JAMA Int Med 2017
7 Physicians of the Future Before meeting the actual person in the hospital or clinic, residents often get to know an electronic facsimile of a patient an ipatient. [Verghese, NEJM 2008] Internal Medicine residents spend more time at the computer than they do providing direct patient care. [Oxentenko, J Grad Med Educ 2012]
8 Do You Really Know Your i-patient?
9 Humans communicate and interpret their experiences through stories 158 narratives May 2011-July 2013 JAMA (A Piece of My Mind) NEJM (Perspectives) AIM (On Being a Doctor) Moniz, Lingard, Whating, JAMA 2017
10 5 Lessons Practicing medicine is a privilege Patients are vulnerable Physicians are fallible Humanity matters The system is flawed 6 Narrative Strategies A rediscovery A quest A hero story A testimony An awakening A lament Moniz, Lingard, Whating, JAMA 2017
11 Stories Can.. Help us process angst Make meaning Connect the past and present Create or reshape our identities Build community with others What about the role of stories at the end of life?
12 Overall Goal of The 3 Wishes Project To improve the quality of the dying experience for patients and their families
13 Premise of the 3 Wishes Project Eliciting then implementing wishes in the hope of bringing peace to the final days or hours of a patient s life, and ease the grief for those left behind Wishes may be those of the patient their family members ICU clinicians 3 Wishes team
14 Objectives For patients, to dignify their death and celebrate their life For family members, to humanize the dying process and create positive memories For ICU clinicians, to foster patient and family-centered care and inspire a deeper sense of our vocation
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16 Wish of a Granddaughter for her Grandfather
17 Wish of a Nurse: The Story of Marriage From His Perspective Just keep this in mind. There will be good days. There will be bad days. There will be days when you wished that you never got married. But as long as the good days out-weigh the bad days, I reckon you are doing alright.
18 Schencker, Palliative & Supportive Care, 2015
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20 Bedside Nurse and they started to remember things about the patient and talk about significant things in his life and who he was and what these words represented, I just saw that somehow, it was calming for them it gave them time to really sit and talk and remember.
21 Family Receiving a family framed cloud meant more to us than anything. It was wonderful...a keepsake in our mother s honor.
22 A model of humane care, whereby clinicians recognize, absorb, interpret, and are moved by patients stories Word clouds tell stories, forge and enrich relationships, and foster compassion Vanstone, BMJ Supportive & Palliative Care 2016
23 J Pain Sympt Mngment 2016 Clinical Empirical Definition: a virtuous response that seeks to address the suffering and needs of a person through relational understanding and action
24 Narrative Medicine The ultimate goal of narrative medicine is affiliation that is, a strong connection between human beings, or within the self. Charon, Narrative Medicine 2006
25 Summary Dehumanization in the ICU - physical, verbal & attitudinal can threaten compassion Compassion is more evolved than sympathy & empathy Sharing stories may promote human connection foster compassion ease the grieving process
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