Today's headline: The problem of Hubris - facing ageing and dying by Dr A.G.
This is an important topic that I want to share with you. Reintegration of longterm absences due to chronic diseases & other, this to create a more valuable career path are part of my niches in my Coaching and Mindfulness Profession.
Here you can hear how coaching skills can make such a huge difference to people. Although Dr A Gawande, surgeon and writer, is not using the word coaching, he is clearly referring to coaching skills in this lecture at Edinburgh's royal academy of medicine. This is a great "added value" to our coaching profession.
Find more details about the lecture: http://www.bbc.co.uk/programmes/b04tjdlj
& the transcript on the website: http://downloads.bbc.co.uk/radio4/open-book/2014_reith_lecture3_edinburgh.pdf
Find below a summary of the lecture:
"We are not trained to cope with limits of our knowledge. Slowly coming to realise that we can't fix what we can't fix - ageing and death.
We have put mortality in the hands of people like me, yet we don't know what we are supposed to do. 60% of people die in hospital. 80% die in institutions of some kind. In the 50s the majority died at home.
Peg was the piano teacher of my daughter. She had a rare pelvis cancer. Then leukaemia from the chemotherapy and original cancer was back and growing in liver. Treatment not working. Immobilising pain. Incontinent. She wanted to know "what to try next?" Options: giving up or everything at all cost. Neither good. Bothered me.
I interviewed more than 200 families about their experience with serious illness. Also palliative care doctors, nurses, geriatricians... Some people did know what to do.
Two lessons: we have failed to recognise that people have priorities they want us to serve besides living longer. Cognitive functions preserved, being at home...
The most reliable way to learn is to ask. We don't.
Less than a third of people out of a group of people who had only a few months left to live were asked what their priorities were. These were more likely to die at home and with their families. 6 months after their death their relatives were less likely to suffer from depression.
The way people deal with their anxiety is not by being told facts and figures but by saying the truth for themselves, in their own words.
I created a check list from what people told me they wanted from us (doctors):
- that we talk less than 50% of the time (I was talking 90%)
- If we talk, ask questions:
what is your understanding of where you are with your condition?
What are your fears or worries about the future?
What are your goals if time is short?
What outcomes would be unacceptable to you?
Not everybody can answer and answers can change, we have to keep asking.
Peg when asked : 1st time saying out loud she is going to die. Angry that there is nothing they can do. Fear of losing control of her body, of dying in hospital, of suffering. Assisted death could be the option for some people. Instead I offered going home with hospice care. The hospice nurse sees her role as using her capabilities to give people the best possible day to day, irrelevant of how long. Ironically people in hospice care live longer.
Peg was back home. Priority was first to deal with physical difficulties and managing pain. Anxieties then plummeted and she got a clear view of what she wanted: to teach, which required careful planning. Sweet spot of medication with morphine. She wanted to share with these kids, pass wisdom, make some last contributions to the world. This is how one shapes the story of one's life, give it meaning.
The way we neglect this is a source of shame.
Concerts were organised for Peg at home, of people she had taught; children's recitals; she had a personal gift and a few words for each of them. She put her arm round my daughter and said "you are special".
50 years of medicalising death is an experiment that is failing.
To learn what matters most to people besides surviving and to use our capabilities to protect those priorities people have; that is our opportunity."
Dr A Gawande's lecture on 9/12/14.