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• Challenges At the Frontlines
  Nancy Lutwak
  Published on: 26 May 2017

• Published on: 26 May 2017

  Challenges At the Frontlines

  • Nancy Lutwak, Physician

  At the frontlines, in the emergency department, clinicians face multiple challenges. Each patient sees his situation as unique and quite frightening, although to the clinician, it is commonplace. Therefore, it is paramount for healthcare providers to empathize with each individual. Another challenge for clinicians is having self-insight and viewing each patient in an unbiased manner in order to share meaningful...

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  At the frontlines, in the emergency department, clinicians face multiple challenges. Each patient sees his situation as unique and quite frightening, although to the clinician, it is commonplace. Therefore, it is paramount for healthcare providers to empathize with each individual. Another challenge for clinicians is having self-insight and viewing each patient in an unbiased manner in order to share meaningful dialogues. Recent publications have focused on these issues 1-5.

  Browning, in his recent paper, Sturdy for common things: cultivating moral sensemaking on the front lines of practice, J Med Ethics.2012;38:233 -235, highlights the importance of clinicians knowing themselves to be effective. The author also emphasizes that clinicians need to look at each patient in a new light and realize that this patient and family are attempting to make sense of their dilemma which from their perspective is unique. Browning also focuses on the importance of clinicians comprehending the position of their patients and family members since clinicians will be called upon to discuss life choices. This requires a patient-centered approach with sharing of decision making 1.

  Chetitih, in, Turning the Lens Inward: Cultural Competence and Providers' Values in Health Care Decision Making, Gerontologist. 2012. doi: 10.1093/geront/gns008v also discusses the importance of clinicians understanding themselves to effectively deal with patients and their families. As the older population increases in size, in addition, health care providers will be challenged in dealing with end-of-life care options for many patients. This will require introspection with awareness of personal beliefs and prejudices. It will require health care providers to analyze and understand their own fears and perspectives so that they may deal capably and honestly with patients and their families. This type of introspection, the author feels, will allow clinicians to honor their patient's worldview and be non-judgmental 2.

  In addition, effective clinicians require excellent communication skills. Their conversations with patients and family members lead to shared decisions regarding complex moral choices. This helps the family cope with the crisis they are facing 1-5. Effective communication also ensures that surrogates are accurately informed and able to make knowledgable decisions. Clinicians with the ability to openly discuss with families a plan for end-of-life care assist the family in facing unexpected poor prognoses. Family conferences with shared decision making also increase the chances for best decisions 1-5.

  Ideally, physicians should appreciate the story of each patient and respect the ill patient's sense of loss of control. This challenge requires empathy and a patient-centered approach that is humanistic and compassionate. Healthcare providers that allow older patients who may be facing long, difficult and serious illness a voice in their care are appreciating the frightening situation of their patient 1,4,5.

  Browning importantly underscores that patients and their family members see their stressful situation as unique. They also depend on clinicians, after thoughtful discussion, to help them cope with difficult decisions and fears 1.

  The goals outlined by Browning should be kept in mind by caregivers on the frontlines to improve patient care and increase clinician effectiveness.

  References

  1.Browning DM. Sturdy for common things: cultivating moral sensemaking on the front lines of practice. J Med Ethics.2012;38:233-235.

  2. Chettih M. Turning the Lens Inward: Cultural Competence and Providers' Values in Health Care Decision Making. Gerontologist. 2012. doi: 10.1093/geront/gns008v.

  3.Fisher M, Ridley S. Uncertainty in end-of-life care and shared decision making. Crit Care Resus. 2012;14:87.

  4. Curtis JR, Patrick DL, Shannon SE, Treece PD, et al. The family conference as a focus to improve communication about end-of-life care in the intensive care unit: opportunities for improvement. Crit Care Med.2001;29(2 Suppl):N26-33.

  5. Shapiro J. Illness narratives: reliability, authenticity and the empathetic witness. Med Humanities.2011;37:68-72.

  Conflict of Interest:

  No competing interests.

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  Conflict of Interest:
  None declared.

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