Nneka Sederstrom, director of the Center of Ethics at MedStar Washington Hospital Center in Washington, D.C., about seven years ago noticed that medical residents at the hospital seemed overly stressed. She set out to discover why.
Sederstrom began a program that replaced the standard ethics lecture given all residents with something she called "Moral Distress Rounds.” During the sessions, she asked young residents about the primary cause of stress in their jobs. The told her it came from being required to offer care to terminally ill patients that they believed was overly aggressive.
“We discussed the issues that were causing them to stress, and they were all related to end-of-life care,” Sederstrom said. “They wondered, 'Am I doing the right thing? When I know I'm not doing the right thing, what are my options? The people I want to complain about have the power to destroy my career.'”
The program provided an outlet for rising physicians to vent their frustrations and learn new skills in dealing with the families of the terminally ill, Sederstrom told the 4th annual Lown Institute Conference in Chicago last weekend. The program has been so successful that it has since expanded to include surgical residents.
Approximately 25% of Medicare's $556 billion budget in 2010 was associated with end-of-life services. Healthcare experts at the conference said the best way to make Medicare more affordable and improve quality of care overall is to decrease unnecessary medical interventions. High on the list was heroic interventions near the end of life that have little or no hope of success and often cause great discomfort for the dying patient.
Dr. Joanne Lynn, director of the Altarum Institute's Center for Elder Care and Advanced Illness, said most patient distress is caused when physicians encourage unnecessary testing and hospitalizations. She also noted that patients and their families often express feeling that that their end-of-life wishes are not heard or respected by physicians.
Lynn suggested hospitals implement protocols to address end-of-life care like providing options for individualized care plans and incorporating health and social services. “We need to change what is habitual,” Lynn said. “Let's make a system we want to grow old in.”
Dr. Thomas Cornwell, chief medical officer of the Home Centered Care Institute, said the ideal place for the elderly to die is at home because it leads to the most cost savings and usually respects the wishes of the patient, especially those with spouses.
Lynn emphasized that it is much easier to achieve the wishes of the elderly if healthcare providers collaborate.
That requires training physicians to offer appropriate counseling. Better care for terminally ill patients begins with the physicians, Sederstrom of MedStar said.
“We are building a generation of residents that I think when they become attending [physicians] will practice better medicine because they now have the tools to know how to say no,” Sederstrom said.