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Palliative Care Perspectives : Chapter 9: Working the System and Making a Difference : List of Suggested Interventions

I have begun to a collect a list of interventions that might be accomplished through the initial work of one individual, although it is not comprehensive. Some interventions are clearly of larger scale than others, some requiring the cooperation of a number of individuals. Some require only a single committed person. Some examples have already been undertaken by individuals and groups, and some are at this point only ideas, as far as I know. The key point is that just as there is always something you can do to help an individual patient, so, too, there is always something that can be done to improve the system of care. My hope is that this list will stimulate readers to try something out, whether it is on this list or not, and to share their actions with others.

Education Initiatives

Symptom Management

Decision Making and Communication

My own practice when attending on the wards is to require "an intelligent note" on preferences before attending rounds on all patients. Often, housestaff do not initially take me seriously. When I point out the lack of an intelligent note, they usually protest: "It seemed like a bad time to chat - he was exsanguinating!" or, "He was demented without a family member present." The "curriculum" begins when we can discuss how to incorporate such eventualities into an intelligent note. For example, an intelligent note might state, "Patient is demented and family not available. Prior preferences not documented. Will attempt to contact tomorrow."

Psychosocial Issues

Spiritual Issues

Venues of Care


Making a Difference in a Moment

Anything you do that can be experienced by more than the individual with whom you are working can make a difference simply by modeling good behavior.

Most great acts of history began with the actions of one individual. The challenge, it seems, is for the individual to engage those around him or her, to strike a resonant chord and thereby find allies in a common cause. Clinicians really want to be of help, and we all know in our hearts that we have a vested interest in good care; at some point almost all of us will require it for those we love and for ourselves. This is our strength. If we can engage this common interest in better care for the seriously ill and dying, one can become many.

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Palliative Care Perspectives

James L. Hallenbeck, M.D.

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Copyright 2003 by Oxford University Press, Inc.

The online version of this book is used with permission of the publisher and author on web sites affiliated with the Inter-Institutional Collaborating Network on End-of-life Care (IICN), sponsored by Growth House, Inc.