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  • Palliative care is a very new medical speciality.

  • I’d say palliative care is a philosophy and it’s a way of looking at medicine in

  • a different set of eyes than most of us have been trained.

  • Every day I get asked, “What is palliative care?” I tell families palliative care helps

  • patients and their families in two particular ways. The first thing is, I often will help

  • patients that are having symptoms that are difficult to control. So they and their doctor

  • have been trying to control their pain or their shortness of breath or their nausea,

  • and it’s been a real challenge. They can ask for our expertise in helping them have

  • the most comfort and quality of life that they can for whatever lies ahead for them.

  • There are also a lot of patients and families that we help with making decisions about what

  • type of care do they want, making decisions about potentially end-of-life care. So we

  • help in a multitude of ways and every patient is really different. On one patient, I’ll

  • go in and strictly be seeing them for pain very early in their illness. Other patients

  • we show up and help them with a lot of end-of-life questions and helping them have a dignified

  • and peaceful death.

  • The difference between palliative care and hospice is something that I’m asked very

  • often. Hospice, most people feel like they understand better than palliative care. Hospice

  • is basically the same philosophy as palliative care in that it’s about quality of life

  • and comfort. But hospice is a program that’s limited to the last six months of your life.

  • And palliative care is not a program; it’s a medical specialty that helps with quality

  • of life and comfort, no matter where you are in your illness.

  • When we show up to help a family, we are advocates for that family. Were not there to help

  • make a decision for them, but help to show them what choices and options they have ahead

  • of them and discuss with them their goals and needs and wishes, so we can help them

  • and their medical team make the right choices for their care. There are times when absolutely

  • we are managing symptoms and were continuing all of the therapies that weve been doing.

  • There are other times that were helping families decide when do we stop doing the

  • type of care that were doing and focus more on comfort. It all depends on the patient’s

  • situation and we don’t go in with any preconceived notions; we go in, we know the medical situation,

  • we get to know the family and we help them all come to a consensus on what would be the

  • best thing for this instance.

  • I always say the nurses and the doctors in the hospital are very cure-oriented and it’s

  • hard to kind of come off that orientation every once in a while and look at the big

  • picture, or what I would call the “10-Thousand Foot Viewof what’s going on with people.

  • And to make sure that what we put quality of life and comfort at the forefront of these

  • very life-prolonging in-curative therapies.

  • Choices are really hard for patients; when theyre in the hospital, theyre overwhelmed;

  • they have many people involved in their care. I often say we have a heart doctor and a kidney

  • doctor and a lung doctor, and it’s hard for patients and families to know, “Am I

  • getting better?” “Is mom getting worse?” Because theyre hearing many different things

  • from different teams. So we get involved often to help those patients and families sort through,

  • Are we getting better, are we getting worse?” And if this is not the direction that a patient

  • or family wants to go, we can help answer questions about what is the best thing for

  • them.

  • One of the benefits of our service is that we take whatever time is necessary to get

  • family’s questions answered and get their needs met. We do develop very close bonds

  • off with their families and one of the things that I’ve noticed since starting this specialty

  • is how often families will contact us after theyve left the hospital to let us know

  • how their loved one is doing, update us on how things are going and continue that connection.

  • We often sometimes will see people through multiple hospital stays. And so we get a consult

  • and we say, “Oh, we met them last time we were here and the families are grateful to

  • have us involved again.”

  • I often hear patients and families ask me, “Is this the right thing to do?” And I

  • often say, “There’s no right or wrong answer.” Every person is different. Every

  • person will do something different. There are people who will go through a lot of pain

  • and suffering until the very last moment of their lives and there are people who won’t

  • even start with that and most of us are somewhere in between. But the most important thing is

  • to find out from patients and their families what’s the kind of person they are, what

  • they are willing to go through.

  • Too often we see patients who aren’t able to speak for themselves and were relying

  • on family to help us make decisions. And the families often don’t have a sense of what

  • their loved one would want and it’s a lot of pressure to make heavy decisions when you

  • don’t know. I think also too often our medical system puts too much pressure on patients

  • and families to make decisions and palliative care tries to help explore with the family

  • what the situation is, offer what are the alternatives or what are our choices here

  • and help them make the best appropriate decision for them and their loved ones.

Palliative care is a very new medical speciality.

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緩和ケア - ネブラスカ医療センター (Palliative Care - The Nebraska Medical Center)

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    Precious Annie Liao に公開 2021 年 01 月 14 日
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