practice partner photo: arash moallemi dignity-preserving manner is different than endorsing what someone is doing. No matter what you think of someone’ s choices in life, you can still have conversations about their choices, and why they may be inconsistent with what you think is in their best interests.” Dr. Zlotnik Shaul says the goal – and the professional obligation – is to establish trust and a therapeutic alliance. Speaking to patients in a way that’ s condescending or minimizes their dignity is counterproductive. It can make patients less willing to come forward.“ You want patients to know they can be open because it’ s a safe environment,” says Dr. Zlotnik Shaul.“ If you speak in respectful manner, it’ s more likely you’ ll have a richer discussion.” There’ s an old saying about practice what you preach. However, doctors have to practice without preaching. Moralizing isn’ t a treatment, and judgments coming from medical professionals have particular power and weight, says Dr. Jeff Blackmer, former Director of Ethics for the World Medical Association.“ It’ s one thing to have a conversation about smoking cessation; it’ s another to denigrate that addiction,” he says. Dr. Blackmer, who practises at The Ottawa Hospital Rehabilitation Centre, is also Vice President, Medical Professionalism for the Canadian Medical Association. He brings up another common values-laden topic: seeking alternative care, like reflexology or herbal remedies.“ I’ ve had people tell me their doctor says‘ You’ re flushing your money down the toilet.’ I try to help patients understand the interactions with other approaches,” says Dr. Blackmer.
What well-being means Conflicts can often be smoothed over, but are often heightened during particular times. End-of-life discussions, for instance, can be fraught with tension.
Dr. Randi Zlotnik Shaul
Bean says doctors tend to have quality of life bias versus quantity of life. As a mediator between doctors and families, she facilitates communication and asks the burning questions. To the family:“ When you say you want dad to live as long as possible, what does that mean?” To the doctor:“ When you want dad to be as comfortable as possible, what does that look like?” Those are the sorts of cases where doctors should be mindful of what well-being means to patients and their families.“ The goal is for people to have a lasting moral peace with the choices they make,” says Dr. Zlotnik Shaul. They shouldn’ t be left with unease or lack of clarity because a conversation couldn’ t be open, or their values were dismissed. She says that doctors can also be put in a sticky moral situation when patients ask
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