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Influence of Hospital Culture on Intensity of Care: Liz Dzeng

Influence of Hospital Culture on Intensity of Care: Liz Dzeng

FromGeriPal - A Geriatrics and Palliative Care Podcast


Influence of Hospital Culture on Intensity of Care: Liz Dzeng

FromGeriPal - A Geriatrics and Palliative Care Podcast

ratings:
Length:
47 minutes
Released:
Dec 14, 2023
Format:
Podcast episode

Description

One of the things I love about Liz Dzeng’s work is the way in which it draws upon, echoes, and advances our understanding of the influence of culture on the end of life experience.  This field is not new. In his book The Hour of our Death Philip Aries described a long evolution in western civilization of cultural attitudes towards dying.  More recently Sharon Kaufman 's book And a Time to Die described the ways in which physicians, nurses, hospital systems, and payment mechanisms influenced the hour and manner of patient's deaths. Similarly Jessica Zitter, an intensivist and palliative care doctor analogized the inevitable clinical momentum toward highly aggressive intensive care in US hospitals as a conveyor belt. Today Liz Dzeng discusses her journey towards studying this issue in detail. Having trained in different institutions within the United States and in the United Kingdom, and as both a sociologist and a hospitalist physician, Liz brings a unique perspective and set of skills to this issue. On this podcast we talk about her paper in JAMA Internal Medicine which studied three hospitals that varied in the intensity of care they provided to seriously ill patients. We discuss the moral distress that clinicians felt including, as one physician put it, a sense of your soul being ripped out. At the end we also pay tribute to Randy Curtis, senior author on this paper and mentor to Liz. Eric and I are joined today on this podcast by Anne Kelly palliative care social worker to discuss these issues with Liz. -@alexsmithMD   Additional links: From Liz: “policies that are too restrictive can actually have an opposite of hindering ethically and clinically appropriate practices whereas policies that allow for flexibility and transparency to act ethically can promote high quality end-of-life care” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8883558/   Other papers that are relevant:  JAMA IM 2015: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2212265 JPSM LAT France paper: https://www.jpsmjournal.com/article/S0885-3924(21)00399-7/pdf ICM paper policies: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8883558/ JPSM aggressive care: https://www.jpsmjournal.com/article/S0885-3924(17)30425-6/fulltext BMJ QS moral distress ethical climate: https://qualitysafety.bmj.com/content/27/10/766.long    
Released:
Dec 14, 2023
Format:
Podcast episode

Titles in the series (100)

A geriatrics and palliative care podcast for every health care professional. We invite the brightest minds in geriatrics, hospice, and palliative care to talk about the topics that you care most about, ranging from recently published research in the field to controversies that keep us up at night. You'll laugh, learn and maybe sing along. Hosted by Eric Widera and Alex Smith.