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Hospice rotation proves beneficial to med students
Residents learn surprising things about dying
A third-year medical student sits with an end-stage lung cancer patient who is in hospice. The patient wants to talk, but not about pain or death or advance directives; he wants to know the student's plans for the future.
"I can't believe it," the student would tell his instructor later. "Here is this patient who's dying, and he's interested in knowing my plans for the future."
Such are the sometimes eye-opening lessons learned by Albany (NY) Medical College students who, for the past year, have been required to do a hospice rotation in their third year. The message is that an often-repeated comment by physicians to dying patients — "there's nothing more I can do for you" — is one of the least true, says John Balint, MD, professor emeritus at the medical college and founder of the medical ethics center at Albany Medical .
"The fact is, when a patient is dying is when you can sometimes do more for them than you could before," says Balint, who pushed for years to have a hospice rotation added to the requirements for Albany med students.
For medical students whose primary focus is acute medicine and healing, that's an important distinction, he adds.
Observing hospice care at work
Balint says once there were adequate hospice staff available for the rotation, the requirement was implemented in 2006. Every third-year student spends a week at hospice, almost exclusively with patients and staff in the home care field.
"They do home visits, sit in on a consultation visit where someone is being referred into the hospice program, and sit in on team meetings to see how the team contributes to the care of the patient," says Balint. "A week is too short a rotation to really learn about hospice, but it gives them an idea of what it can do."
Many students are surprised at the smiles on the faces of hospice patients. "That's why we say that telling a patient [that there's no more that the health care team can do] is not true, because the students recognize that just being there and being interested in the patient does a lot," he says.
The value of just being there is an aspect of hospice medicine that surfaces frequently in the essays students are asked to submit at the conclusion of their rotation. Students are asked to write about the three most important things they learned, and why they chose the three that they write about. "The essay is the major measure of whether we are achieving what we want to achieve, and that is that they understand what hospice is all about," says Balint.
Every student thus far (there are 140 third-year students) has written about the effectiveness of the team approach and the benefits it provides to hospice patients, he reports. Two-thirds typically write about the differences between acute care, with the aim of healing, and hospice care and its goal of supportive care at the end of life. "They often comment on spiritual healing and how interesting it is that patients who know they are dying can be smiling and cheerful," he adds.
Even though the rotation is short, its impact is palpable. Albany Medical College teaches a four-year course in clinical ethics that delves into palliative care, but until the rotation, students don't have any personal exposure to palliative care.
Albany Medical is thought to be the first medical college in the country that requires a formal hospice rotation, Balint says, and "it's turned out to be everything we hoped it would be."
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