Administrative medical assisting 5th by lindh chapter06

Chapter The Therapeutic Approach to the Patient with a Life-threatening Illness © 2014 Cengage Learning All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part Life-threatening Illness • Cultural perspective on life-threatening illness – How you live, think, speak, and behave – Viewed differently by different cultures – Family strongest influence • Work with family and belief system © 2014 Cengage Learning All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part Choices in Life-threatening Illness • Urgency of decisions depend on possible life expectancy • Patients have right to choose or refuse treatment • Palliative care focuses on quality of life, relieving symptoms of pain and suffering © 2014 Cengage Learning All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part Choices in Life-threatening Illness • VSED (voluntarily stop eating and drinking) • Total sedation; medication causes unconsciousness and eventually death • In a few states, option to seek aid in dying © 2014 Cengage Learning All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part Choices in Life-threatening Illness • Issues appropriate to discuss with patients facing life-threatening illnesses: – – – – Alternative methods of treatment Pain management and treatment Loss of self image and independence Legal protection • Durable power of attorney for health care or health care proxy • Health care directives • Patient Self-Determination Act © 2014 Cengage Learning All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part Choices in Life-threatening Illness • Issues appropriate to discuss with patients facing life-threatening illnesses: – Finances; insurance coverage – Emotional needs of patient and family – Life-threatening illnesses are family illnesses • Primary patients (the one with the illness) • Secondary patients (family and friends of patient) • Helping patients live their last days is important © 2014 Cengage Learning All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part The Range of Psychological Suffering • Often leads to physical symptoms • Help patients understand that relationships change • Encourage patients to set goals for themselves • Listen carefully and seek clues to nonverbal communication © 2014 Cengage Learning All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part The Patient with HIV/AIDS • Patients will have great stress when diagnosed with HIV or AIDS – May have fairly good health for a period or very serious near-death illness – Recent developments in treatment of HIV infection and AIDS help patients to live longer – Lives greatly compromised because of suppressed immune system © 2014 Cengage Learning All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part The Patient with HIV/AIDS • HIV affects mostly individuals who are relatively young • Treating HIV expensive • Many patients have little or no insurance coverage © 2014 Cengage Learning All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part The Patient with HIV/AIDS • May experience central nervous system involvement • AIDS when patients’ CD4 counts decline to less than 200 • Particular type of opportunistic infection or tumor, AIDS-related brain or lung illness, severe body wasting © 2014 Cengage Learning All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part The Patient with Cancer • Patients believe cancer and death equated • Choosing treatment complicated and has many facets • Treatments are surgery, radiation, chemotherapy or combination © 2014 Cengage Learning All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part The Patient with Cancer • Patients can experience serious side effects from both radiation and chemotherapy • Even when there is “nothing more to do” related to the cancer, there is still “much to do” to maintain comfort © 2014 Cengage Learning All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part The Patient with ESRD • Loss of kidney (renal) function leads to end-stage renal disease (ESRD) • Patients cannot live long unless they receive dialysis or kidney transplant • Dialysis is filtering blood to remove wastes and can sustain life for years • Some patients will opt not to have dialysis and to let death come from kidney failure © 2014 Cengage Learning All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part The Stages of Grief • Dr Elisabeth Kübler-Ross determined stages of grief – – – – – Denial Anger Bargaining Depression Acceptance © 2014 Cengage Learning All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part The Stages of Grief • Not all patients go through all five stages • Some patients go through all five stages over and over again, each time with a little less stress; others get stuck in one stage • No two patients follow the same pattern • Family members also suffer grief and are often in different stages © 2014 Cengage Learning All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part The Stages of Grief • The acronym TEAR – – – – To accept the reality of the loss Experience the pain of the loss Adjust to what was lost Reinvest in a new reality © 2014 Cengage Learning All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part The Challenge for the Medical Assistant • Be sensitive and respectful – Must be comfortable treating all patients • Nonmedical forms of assistance – Referrals to community-based organizations – Recommend support systems – Spiritual support © 2014 Cengage Learning All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part  ... website, in whole or in part The Challenge for the Medical Assistant • Be sensitive and respectful – Must be comfortable treating all patients • Nonmedical forms of assistance – Referrals to community-based... perspective on life-threatening illness – How you live, think, speak, and behave – Viewed differently by different cultures – Family strongest influence • Work with family and belief system © 2014 Cengage