At the heart of underusing palliative care is that no person wants to inflict sadness on another.
Among the synonyms for the adjective ‘brutal’ are cruel, barbarous, callous, heartless, ruthless, and merciless. No one, especially not physicians who are dedicating their lives to relieving sufferings of others, would countenance having any of these adjectives attached to their actions.
A doctor’s personal repertoire of adjectives for their deeds would rather include kind, caring, compassionate, self-sacrificing, merciful, and heartfelt. These adjectives would indeed describe almost all their actions. Physician’s acts of commission are suffused with caring and its family of synonyms. Their brutal mob of attributes inhabits their acts of omission – their act of underusing palliative care for those suffering in their charge.
Allowing a patient’s life to run out without comforting their suffering, without palliative care is a brutal act. This is a brutality that is endured not just by a suffering patient alone. Their anguish is radioactive affecting every loved one and caregiver around them. The neglect of using palliative care to relieve the misery of the sick traumatizes everyone in the medical care world of the very ill. The failure by physicians to consider comfort as ‘medical care’ results in a brutal fallout that afflicts every person ministering to the patient’s needs. This brutal fallout has a name: it is called “burnout.”
Burnout is a widely recognized problem for caregivers – loved ones and professional ones alike. It takes little empathy to imagine the harrowing heartache of watching a loved one abiding in unpalliated suffering. Less appreciated is the distressing disquietude experienced by nurses and physicians caring for those patients who have been reduced to paying rent for their lives with suffering to the disease that has mastered their bodies. It is a piteous pain to see a patient’s death approaching when they have not been told it is coming.
There are unavoidable and necessary therapeutic traumas that we inflict in medicine that can make the ‘burnout’ burn hotter when their use is avoidable and unnecessarily. Among the most merciless, purposeless trauma is futile CPR – not CPR that fails – but CPR that never had any hope of achieving anything other than a violent death or prolonged suffering. An acknowledged cause of PTSD among nurses is the dread of performing hopeless CPR on hopeless patients and then enduring the most dreadful of all – having to actually perform it.
Unsuccessful CPR on patients with lives ahead of them is a poignant pain that is inherent in the practice medicine – it is a pain that cannot be evaded. It is the human cost of caring for mortal humans. But CPR on patients whose lives are behind them needlessly breaks the hearts and scars the spirits of nurses and doctors. These can be breaks that do not heal and scars that do not fade.
No doctor deliberately brutalizes a patient, but doctors are inadvertently callous by failing to understand that the palliation of the emotional and physical woes of disease is their obligation just as much as the medication of the emotional and physical tribulations of sickness. There may be as many reasons for failing to comfort as there are physicians but there may be a simple human reason at the heart of underusing palliative care: no person wants to inflict sadness on another. This is a most distressing thing to have to do. There is a private pain at the heart of this failing in the profession of medicine: it is the painfully woeful task of telling someone that the person they love and did not expect to die – is dead. This is an awful agony both to hear and to speak. It is a truly fearful thing to have as a responsibility.
Fears by their nature terrorize our hearts and minds. We all live in fear of our fears. While this sounds simplistic it has complicated consequences: doctors can become afraid of giving bad news, of giving news they think will hurt, of giving news that they fear will be brutal. So many don’t give it but in doing so they are cruel not only to their patients but to themselves. In denying comfort to their patients, they deny themselves the fulfillment of alleviating the suffering of another.
Medicine is not only about saving the living from dying, it is also about saving the dying from despairing. Physicians have great powers that can only sometimes heal but that can always comfort. To alleviate another’s torment when it is possible is truly heartfelt. To fail to relieve suffering when it is possible is actually heartless. It is a brutality when a patient who has been conquered by their disease is denied comfort by a doctor who has been mastered by their fears.
There is a desperate need for more palliative care to end this brutality endured by the sick, their loved ones, their nurses, and their physicians. Palliative care is also, like anguish, radioactive but it causes a palliative fallout which doesn’t hurt but heals all it falls on. Palliative fallout is a balm for the burnout this brutality engenders and we urgently need much, much more of it to fall everywhere in medical care.
In what feels like a final drive to exercise authority prior to the election, and a potential shift in control of the presidency and administration,
An oncology practice I work with recently called with a challenging question: what do we do with a patient who acted in a threatening manner?
Please log in to your account to comment on this article.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
This webcast, presented by Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, a recognized expert with over 30 years of experience, offers essential strategies to improve outpatient clinical documentation integrity. You will learn how to enhance the accuracy and completeness of patient records by adopting best practices in coding and incorporating Social Determinants of Health (SDOH). The session also highlights the role of technology, such as EHRs and CDI software, in improving documentation quality. By attending, you will gain practical insights into ensuring precise and compliant documentation, supporting patient care, and optimizing reimbursement. This webcast is crucial for those looking to address documentation gaps and elevate their coding practices.
ICD10monitor has teamed up with renowned CDI expert Dr. Erica Remer to bring you an exclusive webcast on how to recognize sepsis, how to get providers to give documentation that will support sepsis, and how to educate to avert sepsis denials. Register now and become a crucial piece of the solution to standardizing sepsis clinical practice, documentation, and coding at your facility.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 RACmonitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
👻Spooky Sale is Back!👻 Get 31% off all three Medlearn brands, using code SPOOKY24.
