Sunday, February 25, 2007

In Practice: Dealing With Death

In Practice: Dealing With Death: "Wollner recommends a seven-step communication process outlined nearly 10 years ago by the Educating Physicians in End of Life Care (EPEC) project. The project — an effort by the American Medical Association and the Robert Wood Johnson Foundation — suggests that physicians approach patients to whom they must give bad news by:

* Preparing. Choose a quiet, comfortable location where there will be no interruptions, turn off pagers and phones, and decide — asking the patient, if possible — who else should be in on the discussion. Adds Wollner, “Make sure you truly know all of the medical details of the patient’s case beforehand.”

* Assessing. Find out what the patient already knows and wants to know. “Some people want every laboratory test, every fact you can give them, while others, often the elderly from other cultures, may say, ‘You’re the doctor, you decide’ or ‘Talk to my son or daughter,’” Wollner says.

* Warning. Old calls this “firing a warning shot.” It is simply saying, “I have some bad news.”

* Describing. Present the facts of the case in a succinct but caring way and in terms that patients with no medical background will e"

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