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Modules:
Introduction
1. Advance Care Planning
2. Communicating Bad News
3. Whole Patient Assessment
4. Pain Management
5. Assisted Suicide Debate
6. Anxiety, Delirium
7. Goals of Care
8. Sudden Illness
9. Medical Futility
10. Common Symptoms
11. Withholding Treatment
12. Last Hours of Living
13. Cultural Issues
14. Religion, Spirituality
15. Legal Issues
16. Social and Psychological
More About:
Hospice Care
Clergy and Faith Communities
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Touch and Gender
Medical Cultures and Cultural Misunderstandings
Suffering
Traditional Medicine
Depression
Body Language
Bad News
Fatalism
Surgery
Food
Literacy
Meaning of Illness
Alternative Medicine
Pain
Imminent Death
Medical Cultures and Cultural Misunderstandings
Medicine as a Subculture
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As a health care professional you are a member of a subculture with a shared vocabulary that is likely unfamiliar to outsiders
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The subculture is further divided by discipline. Much of the rub between physicians and nurses for example is due to slightly different vocabularies, different skills and different jobs, which members of the other profession may not completely understand. Why else do we have team meetings? So much the more for patients
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Clues to Cultural Misunderstanding
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The following clues may signify that a cultural misunderstanding is taking place:
- Repetitious questions from a mentally competent patient or family member
- Polite resistance and “non-compliance”
- Repeated demands or requests for treatments that are not indicated
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Remember that the concept of palliation itself, which seems universal, may not be so. People come to doctors and to hospitals in expectation of cure. They may seek palliative care outside the setting of formal medical care. Therefore it is important to ask every patient about their expectations of outcome for their illness and their goals for care
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Understand that some patients actively engage from the start, while others do not. Non-U.S.-born, limited-English and limited literacy patients may not be so assertive out of respect or intimidation or an unrealistic expectation of medical or miraculous cure
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Life Experiences Contributing to Distrust of Medicine
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Ethnic and racial minority patients may be deeply and justifiably suspicious of health professionals who seem to be withholding care
- African-American men were used as unwitting subjects for unethical research (the Tuskeegee Study)
- Soviet hospitals were used as places of internment for political prisoners
- Holocaust survivors may be very upset by some medical and nursing procedures
- Former POWs and refugee survivors of torture may have re-emergent trauma in times of stress
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Therefore it is very important to understand the life experience of patients who seem uncooperative
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