Jan 2003
Dear Readers: Here's the Article for this Month:
Name of article:
Experience with hospice: Reflections from Third-Year Medical Students
Author(s): Maxwell TL, Passow ES, Plumb J, Sifri RD.
Reference: Journal of Palliative Medicine 2002; 5/5: 721-7
Abstract:
In recognizing the importance of providing experience in palliative care in the home setting, the Department of Family Medicine of the Thomas Jefferson University addedd hospice visits to the community activities for 3rd year medical students in the year 2000.
After having attended a lecture on the philosophy and principles of hospice and palliative care, and after having seen a tape from the Bill Mayer’s Public Broadcasting series "On our own terms", about 75 students spent a day with the hospice nurse visiting home hospice patients.
The students were asked to write an open-ended reflection paper on completion of the rotation on any of their community experiences. Forty-nine reflection papers were examined and categorized for themes by three reviewers having the aim of describing the students’ hospice experience.
The results of the analysis have defined seven themes:
1. The value of hospice and the supportive role of the hospice team.
Many students declared their apprehension in carrying out a hospice visit because they did not know what they would have seen, felt, smelled, heard by the side of a ‘dying’ patient. In fact, for most of them, a hospice was an institution where people went to die and it was not considered to be a "home" where the patients lived in comfort, without pain, even happy and surrounded by their families. For most of the students the thing that remained after the visit was the value of dying at home with dignity and in peace. with the aid of therapeutic, psycosocial and spiritual support, and a good communication with the family and the healthcare givers.
2. The value of empathy.
The students reported the therapeutic importance of sitting beside a patient, listening to their stories and showing their emotion thus letting the patient feel comfortable in showing his/her emotion.
3. The distinction between acceptance and resignation.
Before their visit, many students expected to find the patients bitter, angry, sad and in pain. What they saw instead was that many patients had accepted their end of life and had refused to prolong their life by artificial means.
4. The changing face of hope.
The students realized that the object of hope could change over time and that hospice care gave the patients the opportunity to reflect on their lives.
5. An understanding of death as a natural event.
The students understood that death is a natural process and that "dying" patients are "living" patients, no different from those who are considered "healthy".
6. The quality of family caregiving.
The students noticed that the family dynamics were different in the home than in the hospital setting. They recognized that the family is an integral part of the patient’s story which could be neglected in the hospital setting. The students also realized the burden these family had to bear when the patients are cared for at home.
7. The role of the physician in caring for the dying.
The students realized that the care of the dying patients was "medicine" and that the real practice of medicine is the "total care of a person" and this is a great responsibility for a doctor as well as for a nurse.
Several students were not familiar with the concept of palliative care but they came to understand this concept during the visit.
" You can only fail a patient if you fail to understand and respond to their needs" said a student after the home care visit.
Why I chose this Article:
This report shows that, for the students, visiting patients with terminal cancer in their homes, trained by palliative care specialists, was not only an educational practical training but also an experience of life.
These students may not ever see a "dying" patient in their clinical practice, but they will never forget what they saw, felt, heard, smelled and learned at the side of these patients.
I would suggest that any doctor, whatever his practice, should take a day off to go and visit a dying hospice patient at his/her home.
Regards,
Carla Ripamonti, MD
Member of the Board of Directors, IAHPC
