The reluctance of medical and nursing schools to embrace training upcoming doctors and nurses in the care of the terminal patient is an ongoing problem. This is a badly needed reform that is long overdue. Why the problem? Mostly, the mindset of the medical community is one of actively saving lives, seeing death as the enemy that needs to be fought at all costs. The mindset of not accepting death as a natural process at the end of life, often resulting in futile care. Doctors and nurses are not trained in the classroom while in school to develop appropriate communication skills, acquire technical knowledge to manage pain, or to learn to address the psychosocial and spiritual needs and their families.
Physicians are trained to treat diseases. They address a patient to find out what is wrong and ten do their best to fix it. They are body mechanics. Their skills have been honed to care for patients by treating the underlying disease, rather than by addressing the complex and often idiosyncratic elements of their suffering. Being willing to explore at a deeper level where the patient is in regards to their mental, spiritual and psychosocial life are not being examined. This would be a more holistic and productive part of total patient care. Imagine a doctor who talked with all patients about these matters. Not just a list of physical symptoms are taken by the treating physician but questions are asked about the patients home life, his or her interactions with their family, where they are in their spiritual life and what arrangements they have made for their end-of-life care and last wishes.
In my book, Soul Service: A Hospice Guide to the Emotional and Spiritual Care for the Dying (Balboa Press, 2013) I had an interview with a hospice doctor. Dr. Bush told me that she used to tell her medical students that they had to make a decision to be either a health technician or a healing professional. A health technician could be a great surgeon and be very skilled but patients are looking for heart, so the health technician may not have that to offer.
Introducing the topic of death as a natural occurrence and a normal outcome of life should be part of the medical and nursing school training. Currently most schools are focused on beginning of life issues with clinical rotations in obstetrics, pediatrics and disease management. There are no clinical rotations in hospitals, nursing homes and hospices to train in the areas of caregiving, dying and grief.
Author and medical doctor Bernie Siegel who wrote Love, Medicine and Miracles shared this story with me, “the first hospice was here in CT and no doctors rotated there, I took medical students there, we are not trained to deal with loss and it is never discussed at conferences. I complained about this when I started practice and none of the deans of the schools who trained me even answered my letters.
The word dead isn't used in hospitals either, people are lost, pass, fail etc.
and people die in hospitals at night when doctors and family aren't there to interfere. Death is inevitable and we need to treat the person's experience not just their diagnosis and help them to live while realizing death is not a failure. The sad part is that students who care about people not bodies and became doctors for healthy reasons get no support. ”
We as a country with one of the world’s most advanced medical systems can do a better job of promoting end-of-life care training that incorporates opportunities to learn how to address death, the dying process and the human experience of medical practice.
Christine Cowgill MS,CRC is the author of Soul Service: A Hospice Guideto theEmotional and Spiritual Care for the Dying (Balboa Press: 2013). Christine seeks to make a positive social change in the area of end-of-life care through raising awareness and increasing mandatory training for our upcoming physicians and nurses in the areas of palliative, emotional and spiritual care to the dying. For further information visit www.soulservice.info and her Facebook page Tips For Caregivers for information on all aspects of care for yourself and loved one.