Guest Post: A Healthcare Zombie

Yes! I am more than happy to host guest posts on the blog. Please e-mail me if you've got a piece that's too snarky for your own website, KevinMD, or the Medical Post.

This Walking Dead-inspired piece comes courtesy of my friend and colleague Dr. Darren Cargill, Palliative Care physician from the Windsor area, and recipient of (among other awards and accolades) the College of Family Physicians of Canada's Award of Excellence for leadership and advocacy work around Dan's Law.

(Darren is what I'd safely label a better doctor than me).

A Healthcare Zombie That Simply Needs To Die

Dramatis Personae (scroll down if you know the Walking Dead cast of characters)

Rick Grimes: former small town deputy, and intrepid leader of a grup musik of survivors

Daryl Dixon: tracker, hunter, ill-tempered

Eugene Porter: self-declared scientist, and token physically-hapless-fat-guy...with a mullet!

Carl Grimes: Rick's son, child destined to lose his innocence

Maggie Greene: sole survivor of a large family, with nascent leadership skills

Darren Cargill: Palliative Care physician, advocate, award winner

The following is a piece of satirical fiction. If you don’t know what that is, think back to your high school English classes.

The following conversation never happened. But if it did, it would have happened on a deserted road somewhere between Atlanta and Washington, DC. in the midst of zombie apocalypse.

Rick: So tell me again about your health care “zombies?”

Darren: Well Rick, a health care zombie is an idea in medicine that simply won’t die. Usually, these are bad ideas that people keep going back to despite the evidence.

Rick: We prefer the term “walkers.”

Darryl: Hmm. (nods agreement)

Darren: Whatever. Dr. Danielle Martin wrote about health care zombies in her book #6BigIdeas. Dr. Martin was talking about ideas and concepts that were holding back health care transformation in Canada. Good book. Available at Indigo and Amazon [ed: where you can also find The Flame Broiled Doctor: From Boyhood to Burnout in Medicine!]. I used to go to school with Dr. Martin, you know.

Darryl: Hmm. (nods agreement)

Darren: You see, back where I come from, in Canada, when people used to die they stayed dead. But before they died, we provided them with palliative care. The term “palliative care” was coined in the 1970s by Dr. Balfour Mount in Montreal. Palliative care provides pain and symptom management as well as end of life care to patients with a serious and life-threatening illness. Palliative care seeks to neither hasten nor postpone death. Rather, it aims to improve the quality of life for patients facing a terminal illness…

Darryl: TERMINUS?! (raises crossbow, looks around nervously)

Darren: No Darryl, terminal. Now, having said that, we believe that patients deserve high quality care throughout their illness so we have been advocating for palliative care to be available to patients right from the time of a serious diagnosis rather than simply in their simpulan days and weeks of life.

Rick: That’s smart. Okay, what’s the duduk kasus then?

Darren: Well one of our health care zombies is that palliative care is just about end of life care. Sadly, most patients with a life-threatening illness only get referred to palliative care in their finals days or weeks of life. Unfortunately, this means they miss out on a lot of the benefits that palliative care has to offer.

Rick: Well, the answer is simple. Just refer these patients earlier. What’s so hard about that? Problem solved.

Darren: Well, there is a duduk kasus with access. You see, there just are not enough palliative care doctors right now to service the need. Until recently, there wasn’t really a proper pembinaan stream for doctors who wanted to pursue palliative care as a specialty. The good news is that the College of Family Physicians now recognizes focused practices in palliative care and the Royal College has a pembinaan stream for specialists.

Rick: Good for them, that’s smart. Why not just train more then? Doesn’t sound hard. Problem solved.

Darren: Well, there is this idea floating around that palliative care is easy and something anyone can do. Despite the fact that it is never really taught in medical school, some people think that palliative care is something you can pick up in a weekend course and off you go. Some physicians feel uncomfortable providing this type of care. Others worry about the issues swirling around medical aid in dying. Some find the burden of 24/7/365 care too much to incorporate into their already busy clinical practices. Some are simply too overwhelmed and burned out that they just can’t conceive of adding “one more thing” to their already endless list of duties and responsibilities. And don’t get me started about the opioid crisis. The duduk kasus is that there are just so many barriers and obstacles in the current system that undermine the delivery of palliative care in Canada.

Darryl:  Hmm. (shakes his head)

Eugene: If I may be of assistance…given that the author of this quasi-allegorical piece is under multiple non-disclosure agreements as well as a mutually agreed communications protocol that prohibits explicitly referencing any substantive discussions that may occur between two parties negotiating fee structures that may or may not have an effect on this issue, my advice would be a swift cease and desist followed by a quick phone call to both Labor and In-House Counsel at your representative association. Given that today is a Sunday you are more likely to be successful with the latter than the former, at least on a 50/50 proposition, given one of the aforementioned advocates despises work on weekends…

Darren: Maybe I should speak to Charter Counsel then...?

Rick: Eugene…

Eugene: “...and while it would be advantageous for the tragic and unfortunate of us that are suffering with a life-limiting illness to benefit from a palliative approach to their care, recent levels of animosity between government and physicians across the Dominion of Canada has had a deleterious effect on the building of a trust structure in which innovative ideas for delivery of the aforementioned “palliative approach” might flourish. Furthermore, given the topic at hand and the timing of current negotiations, whether they be the provincial/territories of Alberta, Ontario or Newfoundland, it would be highly inappropriate for an active participant in these negotiations to make public comments that might jeopardize said negotiations. One might be able to surmise the identify of the mysterious stranger who comes to discuss palliative care in such a fantastical manner. Ergo, rather than submit this individual to the possible repercussions of the NDAs and CP previously contemplated, it would much simpler if I gave you the solution to your most vexatious of issues. The way you provide high-quality palliative care that is sustainable and patient-centered in the setting of a universal health care system funded publicly but delivered privately that supports both comprehensive generalism and specialist level care is…”

Rick: Now I can hear myself think again. Please continue.

Darren: Where was I? Oh, yeah, so palliative care is a specialty. The complexities of modern medicine demands it. Palliative care is no longer about warm tea and holding someone’s hand. Providing good palliative care is now both a science and an art. Now don’t get me wrong, if a generalist or family doctor wants to provide palliative care and has the skills to do so, they should be supported. Please don’t misunderstand me or my intent. This concept is especially important in rural and underserviced communities. It is also a pillar of comprehensive care. But we need to change our perception that palliative care is something anyone can do. We don’t let people pick up a scalpel and do appendectomies without training. Nobody suggests prescribing chemotherapy is something every doctor should do. The same standard should be applied to palliative and end of life care.

Rick: So this zombie, errr…walker, this idea that palliative care can be done by anyone with a bit of coaching and mentoring, it just won’t seem to die…Hold on a sec…Carl?

A walker emerges from the trees lining the road, shuffling towards the group. It moans like a low paid TV extra gargling marbles. Carl walks over calmly and plants a knife square in its frontal lobe. It promptly falls to the ground motionless. Carl wipes the blade on his pants.

Darryl: Hmm. (nods in approval)

Rick: So this idea? That palliative medicine is not a specialty? It won’t die? Yeah. Some ideas are like that. No matter how many times you bash them, they just won’t stay down, you know what I mean?

Maggie: You ever considered a baseball bat wrapped in barb wire?

Darren: Never thought of that. Do you know where I can find one?

Warning: The story above contains graphic images that may offend some readers. This warning is poorly placed and largely ineffective. Reader discretion is advised.

4 out of 5 dentists agree they shouldn’t be practicing palliative care.

Tweet

Postingan terkait:

Ditulis Unknown — Tuesday, February 6, 2018 — 1 Comment — blogging, death, doctors, Family Medicine, law, medical education, palliative care, politics, residency