We’ve all been there – watched painfully as our senior or attending fumbles through their words, ignores the fact a patient is actively dying, or simply could have approached a death and dying conversation better. We’ve also been with the senior or attending we want to emulate; through their interaction with a patient and family during an end of life care discussion, the compassion and empathy was palpable – the conversation flowed smoothly and there was dignity in the conclusions drawn.
This website is a point of care tool specifically for medical students and residents, designed by both with the help of several attendings, to fill in gaps in medical education and offer a step-by-step approach to the most common end of life care discussions a medical student or resident is likely to encounter. No death and dying conversation is easy, nor is there a standardized approach, but there are a few basic rules to follow, and the plethora of literature available has been scoured in order to help you feel more prepared before knocking on a door to enter a sacred time between patient, provider, and family involved.
We also know the weight of losing a patient. With nearly 400 physicians committing suicide each year, over 27% of medical students and residents dealing with depression, and 10% struggling with substance abuse, we wanted to also offer coping mechanisms and outlets to deal with death and dying. Death is inevitable; medicine was created to stave it off for a period of time – it always loses. Yet, medical education does not prepare young physicians how to approach end of life care. Remember, dying is not a medical event, but a social, family, and cultural event and a process.
We surveyed 195 medical students, residents, and attendings – when asked about their comfort level in discussing death and dying with patients and their families, 11% were terrified, 27% were uncomfortable, 47% could do it if they had to, 14% felt comfortable, and less than 1% said it was a strength of there’s. Do those numbers bother you? Do you think those numbers would be acceptable if the question were how comfortable they were with reading a chest X-ray? When asked if they thought end of life care should be included in medical education, 100% said yes. We want to be that education, because the lack of informed death and dying discussions in American healthcare is a symptom of a bigger issue that young doctors simply don’t know they don’t know. Trial by fire in end of life care discussions was the standard for many years, and has been supported by the culture and taboo surrounding death and dying. We want to change that.
End of Life Literacy was made possible through the American Academy of Family Physicians and their innovative approach to creating leaders in medicine via the Emerging Leaders Institute. All photography courtesy of Unsplash. All patient names, scenarios, and identifying information have been removed or altered, but teaching points remain intact.