Planning a “Good” Death

Dr. Ken Murray, a retired clinical assistant professor of family medicine at the University of California, wrote a thought-provoking article earlier this year in the Wall Street Journal entitled, “Why Doctors Die Differently.”

The essential point of the paper was captured in the sub-headline, noting that doctors’ experiences throughout their careers teach the limits of treatment and reinforces the importance of the need to plan for the end.

In essence, physicians – and I would add other clinical care providers to that list – know all-too-well that medicine cannot fix all, especially at the end of life.

Murray quotes nursing professor Karen Kehl, who in the article called “Moving Toward Peace:  An Analysis of the Concept of a Good Death,” noted features of a graceful death, such as:

  • Being comfortable
  • Being in control
  • Having a sense of closure
  • Making the most of relationships, and
  • Having family involved in their care.

Unfortunately, in today’s world, many patients experience a death without these attributes. Physicians have seen this so frequently that it influences how they think about the end if their lives too.

Why the disconnect? 

To avoid what may be considered undo influence, physicians try not to impose their own views on the situation.

Providing hard clinical data to enable a patient to make a decision is generally believed to be the extent of the information a physician or care provider should offer.

When asked directly what they would do for themselves, physicians often deflect the question to ensure patients are not overly influenced by their answer:

“It is what you would want to do, not what I would do.” 

This is adherence to the medical ethical principle of autonomy, making sure that patients or their decision-makers make decisions for themselves and without coercion.

But perhaps we have lost something by the answer we provide.  Continue reading

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The Power of Habit

How’s that New Year’s resolution going so far? Still carrying those extra 10, 15 or 20 pounds?

Certainly, if we resolve to do something and put all of our effort behind it, we should be able to do it, right? This type of “free will” is a great part of our traditional view of how we change or conduct our lives and business.

Unfortunately, it is not as simple as that.

I recently read an opinion piece by David Brooks in the New York Times that highlighted a book written by Charles Duhigg called “The Power of Habit.” In the book, Duhigg, who’s also a reporter at the Times, explores research about how our habits determine our actions.

As much as we think free will overcomes all, much of our actions and behaviors are driven by unconscious habits. Duhigg notes that researchers at Duke University calculated that 40% of our actions are governed by habit, not by conscious decisions.

So much for free will!

According to Brooks’ article, researchers have also come to know the structure of habits. Cue, routine, reward is how habits become ingrained.

Duhigg highlights several examples of how people have learned to replace bad habits with good ones, or create new habits.

From the routine use of toothpaste to football coaches creating practice drills to Starbucks baristas, creation of habits will dictate how one responds to a situation even more quickly and routinely.

Changing your neural network not merely based on forming routine or common triggers. These are instead fortified by emotions and strong desires, like the commitment to a higher purpose or gaining admiration.

What does this have to do with Henry Ford Hospital? 

We are going through a world class service training exercise called by the mnemonic, AIDET (Acknowledge, Introduce, Duration, Explanation, Thanks).

The habit that we wish to create is a common greeting and dialogue that forms the basis of our service culture.

I have heard from many that say they already do this in their patient interactions. Me too, except sometimes I do A, I and E, or I, D and T, but not the habit of routinely doing all the elements. I have a hunch you are no different. Continue reading

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The Stanley Cup of Patient Care

I spend a fair amount of time going “South of the Border,” talking to hospital and academic leaders, physicians and others about Henry Ford Hospital – the great doctors, nurses and programs of the Flagship.  

We are very respectful of the Canadian health care system and the great care it provides. When alternatives cannot be provided from Canadian resources, Henry Ford Hospital is there to provide the best of care to the sickest of patients.

As such, we provide clinical support for this extraordinary patient care, at the request of the doctors and providers in Windsor and Essex County, whenever it is needed. 

Most notable of this clinical support is the work that we have done in cardiovascular disease, especially in acute myocardial infarction.

No amount of my discussions of the value of our partnerships compares to this story, especially the video of a true “Miracle on the Boulevard.”

To our cardiovascular surgical team, the surgeons, the anethesiologists, the nurses, and the technicians: This story is better than winning the Stanley Cup.  Continue reading

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Drinking from the Fire Hose

I am not sure exactly what is going on in the world to have caused the major increase in emergency visits and hospitalizations at Henry Ford Hospital over the last several days (or weeks or months). 

Maybe it’s solar winds, sun spots, loss of insurance, inadequate access to primary care, excessive co-pays or the leap year effect? It’s probably a combination of all of the above.

Maintaining high volumes of admissions by and large is good for the hospital. Better than the opposite. 

It’s a bit like: drinking water is good, while drinking water through a fire hose has its problems.

I do know that the teams of nurses, doctor, and all other employees at Henry Ford Hospital have been working at levels that have not been present for almost a decade. 

In the last few months, we’ve had the highest admissions of any January in 11 years, the greatest number of admissions (over 180) and the greatest number of discharges in our recorded history. 

It doesn’t matter if you are working on the front, middle or back end of hospitalization; you are experiencing high work loads, significant stress and strained processes.

Thank you for being here.

I was walking in the emergency department with Ronnie Hall, our COO, who I have worked with for over 25 years. Patients in CAT 1 were very sick, and triage patients, to our surprise, looked even sicker.  

Patients and their families were patient, but weary. Being sick and feeling poorly, waiting in a wheelchair or stretcher to be seen, is no way to spend a beautiful March afternoon.

In the midst of a sea of patients in triage, one of the patients wanted to leave before service could be provided. She was tired and just wanted to go home. Continue reading

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It’s the Little Things (and the Routine Things) That Count

Every day I hear a patient care story at Henry Ford Hospital that absolutely inspires me and fills me with pride. 

Henry Ford Hospital teams work to bring water into the hospital during the August 2003 power outage.

These are often heroic efforts of clinical expertise and team work, with many of our people working against all odds to perform care that saves a patient from what appears to be an impossible situation. These “miracles on the Boulevard” seem almost routine.

Times of crisis also seem to bring out the best in Henry Ford. 

I noticed this years ago when we lost electricity on Campus on two occasions. 

You could not have had a group of people working together more incredibly to overcome not only the obstacles of minimum electrical power, but the even greater challenges of inadequate water so needed for thirst and cleanliness.

I sit back in awe of our people at these times.

Where do we falter?

What is remarkable is that when we fail, it is in the little things or the routine things that we need to perform on a daily basis. The concentrated efforts and energy during a crisis do not always translate as well to our daily tasks.

Not that it is easy to have these bursts of focus at all times. 

As a physician once told me, you can sprint for periods, but you can’t run a marathon by sprinting. It takes a different approach and mindset.

Much of health care is a marathon. Repetitive, frequent, routine, if you will. 

No fan fare in our employee newsletter and no flurry of congratulatory emails on a remarkable effort.

Our true business challenge is to relentlessly focus on day-to-day patient care and to do it as well as it can be done.  It is the most important element to ensure our success as a hospital.

Yet these daily acts – the ones that we must do – count just as much as all of our photo-op moments.  Continue reading

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Tweets from inside the MRI

While I was waiting to get an MRI of my hip, I thought: “I should be tweeting this.”  But a blog is the limit of this man’s social networking skills.

From Facebook to Twitter, it seems half of the world wants to tell the other half of the world every mundane activity that they are experiencing: “Going to the mall!”; “in the car on the Lodge!”; “buying popcorn!”; “solving the global climate crisis!”

Still, I thought you might want to hear from me on the other side of the white coat as I experienced my MRI at Henry Ford Hospital.

If I had a Twitter account and was tweeting during my MRI experience, my tweets may have looked something like this…

 

 

 


Dr. John Popovich

Checking in to x-ray! @HenryFordNews

 


Dr. John Popovich

No, I am not the basketball coach #spurs

 


Dr. John Popovich

Yes I have insurance.
I am sure we take HAP.


Dr. John Popovich

Are any hospital gowns made for someone over 6 feet?

 


Dr. John Popovich

Need two gowns, you don’t want to see what’s behind #youtube

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Care Rounds

As you may have read this week in a Detroit News article, my leadership team and I have recently incorporated care rounding with patients at Henry Ford Hospital into our weekly activities.

You might ask, “What’s new about a physician and an administrative team rounding on patients in a hospital?”

My response? “Quite a bit.”

At Henry Ford Hospital, care rounds concentrate specifically on the general care and services a patient receives.

Although not fully divorced from clinical issues, these rounds bring out issues related to environment, food, communication, ease of use, and general comfort. Quite simply, it is the service aspect of our profession and business.

At the hospital, all of us go about our activities with a specific purpose. As a physician caring for patients, my concentration and intention is primarily on the diagnosis and treatment of the patient. Patients’ needs are generally first viewed from the perspective of their clinical care.

Much is discovered when the lens is focused intently.

I was struck by the application of purposeful activities when studying LEAN-inspired management methods, where so called “waste rounds” had managers stepping out of their usual role (which includes waste reduction in processes) to concentrate fully on eliminating unnecessary steps or use of supplies.

On care rounds, after asking if I can come into the room and talk, I introduce myself and acknowledge the patient formally before asking one simple question: “How has your care been at the hospital?”

Continue reading

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