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The future of palliative care - Issue #3

This week: we've known for a while that the medical model falls short. Now everyone else is starting

The future of palliative care

March 11 · Issue #3 · 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.

This week: we’ve known for a while that the medical model falls short. Now everyone else is starting to see it.

1. When failure won't spark change: messaging matters.
The Washington Post Op-Ed is entitled “Failing to tell patients that nothing will help will only make them suffer more.” Written by a well-meaning retired gastroenterologist. But it’s actually doing our field harm. The meta-message? Doctors are failing by hiding something–a truth that ‘nothing will help’. As public messaging, it’s a mess: scare tactics used to suggest that patients must face a truth (that is untrue), and promote the idea that confrontation is a good communication strategy. The poignant thing: this doctor is pouring his heart out about the failure of the medical model, but even now he doesn’t see the limitations of his own worldview.
Chronically ill patients often aren't told nothing will help, making them suffer more - The Washington Post
2. Are we doing the right thing about opioids? Uh, no.
As Andrew Sullivan writes in New York magazine: it’s not about pharmacology; it’s about despair. “Addiction — to work, to food, to phones, to TV, to video games, to porn, to news, and to drugs — is all around us.” What would really work would look very different than our current war on drugs. And then there’s our medical culture: I was just part of an LOI declined because opioids and addiction didn’t seem bad enough to warrant goals of care conversations. The study section manager helpfully suggested the PI try “Wellness.” Indeed. 
Andrew Sullivan on the Opioid Epidemic in America
3. You can treat depression with...a cow?
The Cambodian farmer lost his leg to a land mine. An artificial leg couldn’t restore his ability to work in rice paddies–it was too painful–and he became deeply depressed. What helped–SSRIs, therapy, yoga? No. The cure came in the form of a cow, and a new life as a dairy farmer. Writes Johann Hari in Vox: “I came to believe that this little scene in Southeast Asia, which at first sounds just idiosyncratic, deeply “foreign,” in fact represents in a distilled form a shift in perspective that many of us need to make if we are going to make progress in tackling the epidemic of depression, anxiety, and despair spreading like a thick tar across our culture.”
We need new kinds of antidepressants, in addition to pills - Vox
4. Is the medical model ripe for overthrow?
A prominent British policy group concluded that the NHS should shift its focus to include more attention to social determinants of health–because of “deficiencies that are inherent in the medical model, around overdiagnosis, overtreatment, wasteful use of resources.” The Vice Chair of the Royal College of General Practitioners went on to say: “The medical model is so dominant, so seductive in the health service, that unless we challenge it in a very concerted and focused way, we’re not going to be able to develop an alternative.” [If you don’t have BMJ access]
5. Hospitals = the dinosaurs of our time?
Zeke Emanuel, in the New York Times, explains that even though US hospitals represent an economy the size of Spain, they are in decline. Hospitalizations peaked back in 1981. Care is moving from expensive, dangerous, hospitals–to clinics, homes, and long term facilities–at the same time it seems that the medical model is undergoing a kind of slow death. Will we continue to honor and embrace these sacred cows, or can we find the collective will to pursue what Robert Reich calls the ‘common good?’ Just making the diagnosis won’t be enough.
Are Hospitals Becoming Obsolete? - The New York Times
This newsletter is made possible by the John A. Hartford Foundation. But the views, opinions, and recommendations are my own. A hat tip to Bob Arnold for the pointer to Andrew Sullivan!
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