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MIS4- The physician as healer
MIS4- The physician as healer
Recently, I went to campus health, particularly in the mental health section, to collect the medication that I was supposed to collect two months ago. I defaulted on the medication that I was prescribed by the psychiatrist. I thought I was getting better and therefore I did not need to take my medication, additionally my family and friends did not support the idea that I was consuming medication for mental health issues. I started experiencing panic attacks and dysregulation in my mood patterns. I then decided to consult campus health for my pills. The psychiatric nurse made me aware of my inconsistency of taking pills. She told me the consequences of defaulting and the importance of taking care of my mental health. She further explained her own story dealing with depression and how prioritising her mental health helped her to become better. The fact that she os a psychiatric nurse who also dealt with depression moved me and made me want to help myself overcome depression. I would say what really empowered me as her sharing her story with me even though it was the first time seeing me and the fact that she is now working as psychiatric nurse.
FIRST VISIT REFLECTION
When we chose to explore palliative care, it was not due to a deep understanding of the field but rather out of a need for healthcare practice. Our initial visit was an eye-opening experience, as we learned that palliative care focuses on holistic, multidisciplinary support for patients and their families dealing with life-threatening illnesses. This care extends beyond medical treatment, equipping family members with the skills to care for their loved ones, as the patient's well-being often depends on familial support. Palliative care begins at the time of diagnosis and involves collaboration among various professionals, including doctors, nurses, social workers, and spiritual carers. However, one of the primary challenges faced by the field is the lack of staff and resources. The emphasis on effective communication stood out to me, particularly the need to ask thoughtful questions that address the emotional, not just physical, aspects of the patient's experience. This approach aligns with what we have learned in our FAMH 1004A and PFC courses, where understanding the holistic needs of the patient is essential to providing quality care. This experience reaffirmed the importance of compassionate communication and emotional support in healthcare.
SECOND VISIT REFLECTION
I was assigned to by the head doctor to follow two nurses, a clinical palliative care nurse and a spiritual nurse.
During our visit to the wards, we observed several challenges faced by palliative care nurses, particularly in handling the emotional aspects of patient care. One notable issue is the responsibility shifted onto nurses by doctors, especially when it comes to delivering difficult news. For instance, a cancer patient had reached a point where no further treatments could be provided. Despite the gravity of the situation, the doctors left the responsibility to the palliative care nurses to offer emotional support, without directly informing the patient of her prognosis. This leaves nurses in a difficult position as they lack the authority to disclose such critical information.
In addition to this emotional burden, the hospital’s inadequate facilities also stood out. Many pieces of furniture were dilapidated, reflecting a broader issue in public hospitals. This problem was echoed by a patient, Tomm London, who voiced similar concerns about the poor treatment and lack of proper facilities at Helen Joseph Hospital. The combination of emotional strain and substandard infrastructure highlights the pressing need for improvements in both patient care and hospital resources. This experience further emphasised the essential role palliative care teams and spiritual nurses play in providing holistic support amidst such challenging conditions and also highlighted the importance of clear communication in healthcare for better patient care delivery.
REFERENCES
Lindeque, B. (2024). Tom London’s Journey: Hospital Experience Unite Nation. [online] Good Things Guy. Available at: https://www.goodthingsguy.com/people/tom-londons-journey-how-one-mans-hospital-experience-united-a-nation/ [Accessed 14 Nov. 2024].
THIRD VISIT REFLECTION
Today I observed that the palliative care team has a specific routine:
Every morning at 8 AM, before going to the patient wards, they gather in an assembly to praise and pray.
They review which patients they should visit, some are follow-ups, and some are new patients assigned palliative care by their physicians.
Visit the wards.
By 11:00-11:30, they are already done and go back to their workspace, where some meet up with families they scheduled to meet up with, often families of a patient.
My reflection on a case that stood out for me and reminded me what palliative care is all about:
Reflecting on the case of the 77-year-old woman scheduled for a biopsy brought to light some of the ethical complexities within healthcare, particularly in balancing medical education with patient-centered care. The biopsy aimed to assess her cancer, determining its type and stage before considering chemotherapy. However, the nurse expressed concerns, highlighting that the risks of chemotherapy might outweigh the benefits due to the patient’s advanced age, fragile health, and chronic conditions. This decision appeared to be driven, at least in part, by academic purposes, as it would provide valuable learning opportunities for medical students. Observing this situation made me think critically about the potential conflicts between educational goals and patient well-being, and it underscored the role of palliative care in advocating for patients.
The palliative care team’s involvement in cases like this emphasizes their commitment to prioritizing patient comfort and dignity. Their approach is not about extending life at any cost but about ensuring quality of life, even at the end stages. I was reminded of this commitment when I saw the same patient showing visible symptoms of jaundice, such as yellowing of the skin and eyes, signaling the progression of her illness. Through compassionate advocacy, the palliative team sought to ensure that her care would focus on comfort, minimizing pain and providing support for both her and her family.
This experience highlighted a core principle of palliative care: placing the patient’s needs, comfort, and dignity above all else.
FOURTH VISIT REFLECTION
During this visit, I observed that most patients the palliative care department deals with are cancer patients. Most of their patients are elderly with other chronic conditions such as dementia and diabetes.
Reflection on a case that stood out for me:
A case that truly moved me was that of a single mother who had recently undergone a lumpectomy. This surgery removes cancerous tissue while trying to preserve as much of the breast as possible. When asked how she felt about the changes to her body, she expressed a feeling of disembodiment, explaining that she didn’t quite feel like herself anymore. It reminded me of how illness can affect not just a person’s body but also their sense of self.
However, what struck me most was her concern for her three children, the oldest only 13. Despite her own worries, she was mainly focused on how her illness might affect her children’s well-being. In response, the nurses quickly arranged for her to meet with a social worker to ensure that her kids would have the support they needed. This showed how important teamwork and patient-centred care are in healthcare.
This experience highlighted the importance of looking beyond a patient’s immediate medical needs and considering their overall life situation. The care team’s actions showed real compassion, and it taught me that good healthcare means seeing the whole person, not just their disease. This also reminded me about two concepts discussed in class, which was the difference between treating a disease and an illness. A disease is more focused on the physiological aspect of a patient, and an illness is more about seeing the patient as a whole. This is a lesson I’ll carry with me as I continue my journey in medicine.
FIFTH VISIT REFLECTION
Two things stood out for me today:
The importance of collaborations within the healthcare system
The importance of non-discrimination
Reflecting on my experience with dementia patients in palliative care felt particularly personal due to my own grandmother’s struggle with dementia. Our family eventually had to place her in a nursing home, as we were unable to provide the level of care she needed. This experience taught me just how essential compassionate, consistent care is for patients with dementia and the families who may not have the resources or time to care for them directly. During my shadowing, I encountered a dementia patient who was being discharged and assigned to home-based care. The nurses spoke with her patiently and respectfully, a simple but impactful demonstration of non-discriminatory care. They treated her with the same level of dignity and empathy as they would any other patient, despite her cognitive challenges.
However, home-based care in palliative care settings has limitations due to resource constraints, and unfortunately, it is only available in specific areas. For patients living outside these areas, access to home-based care becomes difficult because there is only one team available. The team primarily works with patients who have an ECOG (Eastern Cooperative Oncology Group) performance status of 3 or 4, patients who are severely impaired and cannot perform most daily tasks independently. To overcome these limitations, the palliative care team partners with an organization called "Wobots," which has a broader presence. This organization helps fill the gap, allowing patients outside the hospital’s reach to receive essential home-based care. This partnership exemplifies the importance of collaboration within the healthcare system, ensuring that patients, regardless of where they live, have access to the care they need.
The case of the 29-year-old patient from Zimbabwe highlighted the importance of non-discrimination within the healthcare team at Chris Hani Baragwanath Hospital. Despite her being a foreign national with limited support, the healthcare practitioners treated her with the same level of care and compassion as they would any other patient. This patient, facing kidney failure and HIV with no family or financial support, had endured many hardships. After her boyfriend abandoned her and her uncle refused to take responsibility, she was left with little to no social support system. Despite these challenges, the healthcare team provided her with the necessary medical care and emotional support, showing deep respect for her dignity and well-being.
At Chris Hani Baragwanath Hospital, non-discrimination is evident in the way healthcare practitioners approach all patients, regardless of nationality, background, or social circumstances. The healthcare practitioners treated her as they would any other patient, ensuring she received the best possible care. They didn’t let her non-South African status influence their commitment to her comfort and dignity in her final days. This also emphasises the duty of healthcare practitioners to respect patients' rights to health.
References
Olson, H. (2023). Understanding the Patient Bill of Rights: Empowering Patients for Quality Healthcare. [online] Patient Advocate Info. Available at: https://patientadvocateinfo.com/legal/understanding-the-patient-bill-of-rights-empowering-patients-for-quality-healthcare/.
M11S2
HCP-Patient Follow-Up Reflection: Breast Cancer Case
One of the most memorable follow-up interactions I observed during my shadowing experience was with a single mother recovering from a lumpectomy. A lumpectomy is a surgical procedure to remove cancerous tissue while preserving as much of the breast as possible. The patient was returning for a post-surgical check-up to discuss her progress, manage her concerns, and plan the next steps in her treatment.
A recreation of the conversation model:
Nurse: Good afternoon, Ms. Y. How have you been feeling since the surgery? Are you experiencing any pain or discomfort?
Patient: The pain isn’t too bad now, but I feel strange. My body just doesn’t feel like mine anymore. I look in the mirror, and it’s hard to recognize myself.
Nurse: I understand how difficult that can be. It’s common to feel this way after surgery, especially one that changes how you see yourself. Would you like to talk more about how it’s affecting you?
Patient: I just don’t feel like myself anymore. But honestly, I’m more worried about my kids than myself. My eldest is only 13, and I don’t know how to manage everything while I recover.
Nurse: Your concerns are completely valid. Taking care of your children while focusing on your health can feel overwhelming. Have you spoken to anyone about getting additional support?
Patient: Not yet. I don’t want to burden anyone, but I know I need help.
Nurse: You’re not alone, and it’s okay to ask for help. I can arrange for you to meet with a social worker who can help with childcare arrangements or other resources to support you during this time. Would that be helpful?
Patient: Yes, please. That would take a lot off my mind.
Nurse: Of course. We’re here to support you and your family. In the meantime, if you have any concerns about your recovery or just need to talk, don’t hesitate to reach out.
Reflection on Patient-Centredness
This follow-up demonstrated a deeply patient-centred approach, addressing both the physical and emotional impact of the patient’s surgery. The nurse began by enquiring about the patient’s recovery, carefully listening to her concerns about pain and self-image. By creating a safe space for the patient to express feelings of disembodiment, the nurse acknowledged the profound emotional toll of breast cancer treatment and provided reassurance without judgement.
The conversation naturally shifted to the patient’s worries about her children, reflecting the holistic nature of palliative care. Recognising the patient’s priorities, the nurse immediately suggested involving a social worker to ensure that her family’s needs were met while she focused on her recovery. This practical and empathetic response demonstrated how interprofessional collaboration can address complex challenges, extending care beyond medical treatment to include social and emotional support.
By validating the patient’s feelings and involving her in decisions about her care, the nurse ensured that the interaction respected the patient’s dignity and autonomy. This follow-up was a powerful example of patient-centred care, showing that addressing the full scope of a patient’s needs, physical, emotional, and familial is essential for effective and compassionate healthcare.
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