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The future of palliative care - Issue #14


The future of palliative care

June 10 · Issue #14 · View online

In many respects, we've arrived. Yet what we know now won't get us to the next level. So I'm looking for signals from the future, & I'm curating them here.

“The illiterates of the 21st century will not be those who cannot read and write but those who cannot learn, unlearn, and relearn.” Alvin Toffler

"Ikigai" = Japanese for what you should really be doing now.
"Ikigai" = Japanese for what you should really be doing now.
1. Hospital culture is something you can shape.
A 2-year, mixed-methods interventional study in 10 US hospitals targeted 5 domains of organizational culture: (1) learning environment, (2) senior management support, (3) psychological safety, (4) commitment to the organisation and (5) time for improvement. Six of the 10 hospitals achieved ‘substantial’ changes in culture–and those hospitals improved their risk-standardized mortality rates more than the others. The lesson for palliative care: could we start to think bigger than single interventions, up to the level of organizational culture, intentionally and strategically?
Influencing organisational culture to improve hospital performance in care of patients with acute myocardial infarction: a mixed-methods intervention study | BMJ Quality & Safety
2. How anger & fear are shaping medical culture now.
Atul Gawande, for the graduating class at UCLA: “We are in a dangerous moment because every kind of curiosity is under attack—scientific curiosity, journalistic curiosity, artistic curiosity, cultural curiosity. This is what happens when the abiding emotions have become anger and fear.” In the incident he relates, he illustrates a foundational communication skill–he names the emotion: “You seem really angry and like you feel disrespected.” Could our ability as clinicians to work with strong emotions be the skill that takes us from a culture of procedures towards a culture of respect & care.
Atul Gawande: Curiosity and What Equality Really Means
3. Have we forgotten how to die?
“Although we greedily consume death at a distance through fiction, drama and the media, we are hamstrung by it up close and personal.” Julie-Marie Strange in the Times Literary Supplement, curates an interesting collection of non-fiction about the culture of death now. What she finds is an update of Phillipe Aries’ classic study: “Modern death, in contrast [to death in the past], was privatized, medicalized and emotionally stunted.” Does a public engagement strategy need to help create ‘a holding space–a temporal, emotional and spatial interlude’ that spans popular and medical culture?
Have we forgotten how to die?
4. If you're dying & strapped, crowdfund your funeral.
In the absence of a holding space, people use the community spaces that they’ve got. From the New York Times: “GoFundMe, one of the largest fund-raising sites, says that 13 percent of its campaigns created in 2017 were described as memorials, which include funerals and are one of the company’s fastest growing categories.” The executive director of the Funeral Consumers Alliance comments “This is an indication of where we are as a society.“ Naturally, you can be coached on ‘what angles to pursue to make a campaign go viral.’ It’s the postmodern equivalent of grief. 
Crowdfunding a Funeral: How the Internet Helps Lay Affairs to Rest - The New York Times
5. Do we need to decolonize the experience of dying?
From a fascinating about how the world of art museums are struggling with a different kind of problem legacy, in Hyperallergic–in powerful statement from critics of a Brooklyn Museum curator hire: “We belong to communities that are, at one and the same time, engaged in day-to-day struggles against settler-colonialism, white supremacy, patriarchal violence, police terror, mass incarceration, population displacement, deportation, economic precarity, and climate disaster. As Audre Lorde put it, “There is no such thing as a single-issue struggle because we do not live single-issue lives.” Why this is relevant to palliative care is evident to me in the increasing disjunctions between palliative care and practices for dying that are currently at the margins–medically assisted dying at one extreme, and psychedelics at the other. We need discussions framed in ways other than demands for ‘rights’ and professional privilege. We need a holding space.
Growing Coalition Calls Brooklyn Museum "Out of Touch" and Demands Decolonization Commission
6. What Anthony Bourdain's death reveals.
Hey Tony, i'm missing you already.
Hey Tony, i'm missing you already.
Listen to how Bourdain describes dinner with Obama on a plastic stool in Hanoi, eating bun cha. Then look at the thread of stories in Eater: a veritable lesson in how we grieve now.
Anthony Bourdain’s Interview with David Remnick | The New Yorker
Anthony Bourdain Dead: Global Food Celebrity Dies at 61 - Eater
This newsletter is possible because of the good people at the John A Hartford Foundation. (See what Terry Fulmer & I wrote about Barbara Bush here.) But the opinions and recommendations in this newsletter are mine alone.
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