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End of Life From My Side of The Gurney | Dr. Brian Goldman
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End of Life From My Side of The Gurney | Dr. Brian Goldman

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A presentation made by Dr. Brian Goldman during the free public forum "How to Start the Conversation: a discussion on preparing for end-of-life care" on January 9, 2014 at the United Steelworkers Hall ...

A presentation made by Dr. Brian Goldman during the free public forum "How to Start the Conversation: a discussion on preparing for end-of-life care" on January 9, 2014 at the United Steelworkers Hall in Sudbury, Ontario.

Dr. Brian Goldman is an Emergency Department physician at Mount Sinai Hospital in Toronto and host of the national CBC radio program “White Coat, Black Art”.

Learn more about the forum at http://www.hsnsudbury.ca/events

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    End of Life From My Side of The Gurney | Dr. Brian Goldman End of Life From My Side of The Gurney | Dr. Brian Goldman Presentation Transcript

    • White Coat, Black Art Health Professionals open up about their profession End of Life From My Side of The Gurney End of Life Public Forum Steelworkers Hall, Sudbury Dr. Brian Goldman January 9, 2014
    • Empathy Gap
    • Silver Tsunami! Seniors: fastest growing population segment in Canada • 2008: 4.2 million • Canadians > 65 • 2050: 1/4 Canada’s population Statistics Canada
    • Crisis of Chronic Disease • Exemplar conditions: – arthritis, diabetes, heart disease, cancer, chronic pain, depression, vision and hearing loss, trauma (MVCs) • Chronic diseases are the leading causes of death and disability worldwide • Canada: 2 of every 3 deaths • US: accounts for 75% of $2 trillion annual health care spending
    • A New Normal Across Canada • 5 million Canadians can’t find a family doctor (StatsCan) • Especially true in places like Sudbury • Elsewhere, doctors cherry-pick patients • Many Canadians have no access to primary care
    • So, They Come in Droves to the ER • “Slammed” • “Inundated” • “Swamped” A system in which patients are seen as the enemy
    • Argot • “A secret language used by various groups – including, but not limited to thieves and other criminals – to prevent outsiders from understanding their conversations.” • Derivation: a group of thieves circa 1628 knows as les argotiers
    • Talk in Plain Site
    • Contemporary ‘GOMER’ Slang • Social admission • Failure to Cope, dyscopia • FTD – Failure to Die
    • Why Aren’t We Nice to Elderly Patients • Not well trained in geriatrics • Don’t value the work of geriatrics • Not high-tech diagnosis and treatment Dr. Samir Sinha: one of just 250 Geriatricians. We need 500 more!
    • Everybody Dies • Healthy people don’t die • When we eradicate today’s diseases, there will be others • We spend more $ in the last two years of life than all other years combined. • We won’t control health costs until we tackle the $ we waste at the end of life
    • Medical Futility • No ‘official’ definitions • Like bailing a well with a sieve • Basically, offering lifeprolonging treatment without hope of success • Health professionals believe they know it when they see it
    • ‘Getting’ the DNR • Do Not Resuscitate: cardiac resuscitation the only procedure that must take place UNLESS patient or next of kin refuse it • No long a question of CPR or ventilator: large & confusing menu of options • Getting the DNR = getting a form signed • Families unprepared to talk about DNR immediately after learning that a loved one is likely to die
    • ‘Slow’ Code • Cardiac arrest featuring neither speed nor full therapeutic 'firepower’. – Hollywood code, light blue code, blue lite code, partial code • Mike Evans: “It’s malpractice. If you’re called to a code, you go.” • Use of the term reflects deep distress that HCPs feel about running a full code in a medical futile scenario
    • So, Who’s to Blame? • Health professionals blame families for not stating their wishes via advance directives • Families say their wishes aren’t followed
    • The Surprising View From Listeners “"It seems to me you are working from an incorrect premise. Many people feel pressured to receive treatment that prolongs life against our will. My 97 year old mother-in-law had a Do Not Resuscitate order. A day before her death, we found her attached to all the equipment necessary for resuscitation. It was only after I reminded the doctors that she had a Do Not Resuscitate that she was permitted to return to a familiar place." Adel Elias, Campbell River, BC
    • Clash of Views • Hassan Rasouli went into hospital to have neurosurgery • Post-op infection left him on a ventilator in a “near vegetative state” • His MDs applied to the courts to remove life support • His family believes he is conscious & fought the MDs • SCOC: sided with the family • Now about to be transferred to LTC facility
    • • In June 2010, Senator Sharon Carstairs published her final report on the future of palliative care in Canada: – 90% of Canadians will reach a stage in their lives at which they would benefit from palliative care – 70% won’t receive it – What we must do is to celebrate death as we do birth
    • • In 1990, Ian Anderson died of colon cancer • His wife Margaret cared for him at home • In 1997, she founded Ian Anderson House • There aren’t enough hospices for patients who need them
    • Palliative = Panacea? • True story: patient receiving palliative care for terminal cancer • Patient’s usual palliative care MD says DNR • Patient arrives in the ED of a different hospital with trouble breathing • Palliative care MD at the different hospital said full resuscitation
    • The Rational Patient Who Wants to Kill Himself • Nagui Morcos: early 50s, diagnosed with HD, watched his father die of HD • Ended his own life in April 2012
    • BC Supreme Court of Canada • Gloria Taylor & 4 other plaintiffs applied for doctorassisted death • Taylor received an exception that would have permitted her to have a doctor-assisted death pending the outcome of the case • She died of natural causes • BC Court of Appeal recently upheld federal ban
    • The Latest in Quebec: 2014 • About to become the first province in Canada to allow doctor-assisted death • Some believe Quebec will become the preferred destination for Canadians who would have gone instead to Europe.
    • Reaction to Quebec Proposal • Bioethicist Margaret Somerville: “The Quebec report is not balanced and reads like a pro-euthanasia manifesto.” • “Can we even imagine teaching medical students how to kill a patient?” • Judging by surveys, the public interest in this proposal is not matched by interest in the medical profession.
    • Unfortunately, many health professionals only learn about empathy when they or their loved ones experience health care as patients. I learned more about health care from my parents Sam and Shirley Goldman than I did from textbooks.
    • Sign Your Advance Directives