Palliative Care, a Different Voice in Healthcare: Timothy Ihrig at TEDxDesMoines
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- Опубліковано 8 вер 2013
- Healthcare expenditure is the biggest threat to America's economy, due to an aging population and a system in which physicians are often paid based on what they do to their patients, rather than fostering a patient's overall quality of life. Dr. Timothy Ihrig explains the benefits of palliative care that prioritizes a patient's personal values and navigates a serious illness from diagnosis to death with dignity and compassion.
In the spirit of ideas worth spreading, TEDx is a program of local, self-organized events that bring people together to share a TED-like experience. At a TEDx event, TEDTalks video and live speakers combine to spark deep discussion and connection in a small group. These local, self-organized events are branded TEDx, where x = independently organized TED event. The TED Conference provides general guidance for the TEDx program, but individual TEDx events are self-organized.* (*Subject to certain rules and regulations)
I am on month 2 of palliative care. I have lung cancer (just one tumor so far) and end stage copd. I feel great, I'm in no pain. I refuse chemo as I know it won't be cancer that takes me out first, so why put myself through that. I have a fabulous team of doctors and nurses. I'm happy because I'm not in a nursing home or a hospital. At this point, other than heavy lifting I can still take care of myself. I'm always short of breath but not nearly as bad as before. I thank my doctors every visit for offering this care because they also told me they aren't abandoning me. I still have my regular visits to them, and my weekly calls and monthly visit from palliative care. It's something I wish was offered to both my parents but sadly, it didn't exist, at least not at the level it is for me, I'm 65 and may or may not hit 66 but I'm happy and I'm grateful for my 65 trips around the sun.
This is the most on point TedX I have heard in my life. This doctor - this human being - "gets" life and the human experience. I would be honored to be his patient; I am blessed to have a physician who shares his overall mindset in some key aspects. The palliative care philosophy works for my situation and my health struggles; I imagine it could help many more people, if it was more universally understood that palliative care is not only for the dying. It is also - very much so - healing, authentic, calming, and meaningful for the living, as it is a quality of life and patient-centered approach. I have met many doctors in my time seeking health. A marker of a physician's ability to support me and connect with me is connected to whether or not they ask me "what is important to you?", and "what are your goals" or "what do you want to be able to do again in the short/mid/long-term future"?
Not enough stars to give to this talk. Incredibly informative! Thanks for being so open.
My aunt passed 6 days ago. To her last breath...she was living! She spent her last week's at home with her daughter and family with fantastic home paliative care. Thank you
Much appreciated for a sound presentation and palliative approach...gives an emphasis to my nursing service with palliative care persons...
Treat the heart and mind, the body will follow.
Exceptional talk, Tim! I feel honored to know you and proud that you are raising these issues that are important to all of us.
My Grandfather died on Tuesday. He was 96 years-old and had never been sick a day in his life. Seriously, the worst thing he had was a hernia from lifting my grandmother several years ago (before he had to put her in a nursing home) and surgery to remove gallstones. He still drove everyday and kept busy playing golf. He had fought in WWII and ran a successful business for many years. On Tuesday, he was sitting talking to my aunt and said all of the sudden that he didn't feel good. He stood up and fell down to the ground dead. That quick. I seriously thought he was going to live past 100. I was absolutely shocked to say the least. Honestly, I am still having a hard time wrapping my mind around it. I understand that a lot of people don't understand why I am upset or shocked that a 96 year-old died, but they just don't know my Grandfather! I do find comfort in knowing that since everyone has to die, his was quick with as little suffering as possible. I am thankful that he didn't languish in a nursing home like my grandmother did for years before she died. She died 2 years ago. He was her caretaker until he physically couldn't keep lifting her anymore. He visited her every single day sometimes twice a day when she was in the nursing home even though she hadn't known who he was in years. Selfishly, I wish I could have said goodbye, but I find peace and strength knowing that he did not suffer and that they are together again!
Thank you! Yes, and we are burying him tomorrow because we had to wait until a date opened up at the veteran's cemetery. He served active duty in WWII, so I guess they are doing something special. His funeral was Friday and it was such a lovely service! He still did so much to bring joy to others daily up until the day he died. Nurses from the nursing home where my grandmother had been before she passed came and spoke about how even after she died, my Grandfather still came once a week to visit with and help feed patients that didn't have anyone to visit them. He took a art class at his church and the teacher spoke and said that he was the "class comedian"! He was always serving others and bringing a smile to people's faces. He made the most of his 96 years and I was blessed to know him. I hope I can live as good of a life as he did and have had as much of a positive impact on others as he did when I die.
My grandpa died when he was 90. That was a long long time ago and it took me half my life to finally embrace the fact that he had lived a very long life. Unlike your grandpa, mine had gone through a lot: he had an accident which left him paralyzed for almost a year, but he walked again after a year of home therapy given by my grandma; he had a heart condition that was a time bomb, he smoked a lot and his lungs were severely damaged, and the list goes on and on. I thought my grandpa was invincible, I thought he would live a lot longer when we took him to the ER and he entered walking... I was a only 12 years old and I couldn't understand that leaving him five weeks in that hospital, with a tube down his throat to help him breathe, was torture. I still hoped he would come back home and teach me a lot more things. I couldn't say goodbye either. I was at school when he died and my mom waited until school was over to tell me the horrible news and bring me to the service. In time I understood that I don't have to say goodbye, that my faith and the things I believe in make it possible for us to reunite someday, so it's just saying see you later. Another thing I understood after nearly 15 years is that saying goodbye means absolutely nothing: what really counts is the time you spend in each other's company, the memories you built, the laughters, the love you shared when he was alive, because that's something no one can take away from you... or from him. I understand that it is important to us to say a simple word, followed by three other words: I love you, goodbye. But they knew we loved him and maybe it was hard for them to say goodbye to their loved ones. Maybe it would've been much more harder for anyone. I hope that after all these months you found your peace and I can tell you loved your grandpa very much, so I wish you will always keep him in your heart because that way he would have not entirely left.
Lei Zahra your statement about saying goodbye is true. For a long time I thought I would need that when my time came, but I have come close so many times that I have come to see that it is indeed embedded in how we are with those people when we are alive.
@@leilawni Thank you for writing this.
Such a wonderful message! Thanks for sharing your idea!!
I believe the same but many of us around me believe that palliative care is for end of life which Dr, Timothy has explained very clear that palliative care start from the diagnosis and ends with patient's life. Great.......
William Chaman I think you are right that that’s the view now. I believe it should start when we are young adults, as most people are totally unprepared for terminal diagnoses. And consequently they end up freaking out about a very human process and wind up in a hospital bed drooling at the mouth from sedatives or asking for a lethal dose of opiates. That’s not how it should be.
Absolutely 💯. 💯
I really appreciated this video. My husband who is in failing health with dementia and I have spent the last 5 years living to see doctors. It suddenly occurred to us that this was not quality of life. He is just starting palliative care. I had a hard time distinguishing how it differed from hospice since it is billed to Medicare under hospice. I know my husband has spent untold amounts billed to Medicare. I agree this an untenable situation for the American public in the future.
Thank you for sharing such an important message that is widely unknown.
I have to write a paper on this😟
Uuuhhh Professor F.
This is hard🤲
Great talk...
Love TED Talks!
I am a 58 year old woman. I didn't even know this word until today. I married a wonderful man 5 years younger than me. I have told him if anything happens where I end up in the hospital, pull the plug; DNRCC , ( do not resuscitate/compassionate care), no shocking the heart, feeding tube , nothing. I shall add palliative care to that list. No need to leave him in the poor house broke, because of staggering medical costs. This would be my gift to him. I will be home with my Sweet Lord and Savior Christ Jesus, Amen
I strongly agree with Dr. Ihrig’s point regarding taking a patient’s right to choose their medical experience out of their hands when it comes to geriatric populations. Too commonly it seems as though the patients family seems to take their choices out of their hands either through durable power of attorney or even through the guilt of not making it to the next birthday, wedding, among many others. At the behest of loves many older patient’s autonomy is removed from them in a variety of different ways. As physicians, it is extremely important to act in the most ethical way towards patients regarding providing justice to all patient populations, practicing beneficence, and in this particular case, working to preserve patient autonomy and their right to decide their own medical care.
Too often, palliative care is seen as a means to an end. As a medical option used only as a last resort when the patient is going to die. And while it does ease the patient’s symptoms while entering end of life stages, as Dr. Ihrig points out, it can significantly contribute to patient longevity. It seems very clear that a provider’s main goal should be to prevent patient suffering, after all, this is written into the Hippocratic Oath.1 Things, however, can get difficult when considering what this necessarily means which can be far ranging, whether it is easing the physical suffering caused by pain or the emotional suffering through missing some of the major milestones of their growing family. Palliative care however provides an ethically sound option to hit these major points. By providing certain medication, providers can ease patients physical suffering, and, as Dr. Ighir mentions, in certain cases can drastically improve patient longevity to make these milestones.
Major issues however arise in this atmosphere due to a lack of education for both patients and their families. Palliative care is often seen as a one-way road to a patient’s death. However, it should be viewed as an ethically sound decision to consider when someone is suffering, and better alternatives can no longer be provided. When there are no longer any alternatives to treatment or resolution of a terminal illness, palliative care should certainly be considered. It creates the most good for both the patient and their family through many angles. Not to mention, it significantly reduces the economic burden which may be passed on to the patient and perhaps even the family through costly clinical trials and hospital bills. In the coming years, with a generation rapidly approaching the need for increased hospital care, education regarding palliative care should become much more common. It is important for caregivers, family members, and patients to understand the truths and myths about palliative care so that they may make the best decision, and so that patients may retain their autonomy and achieve the most beneficial care available.
1. Pappworth MH. Modern Hippocratic Oath. Letter. Br Med J. Mar 20 1971;1(5750):668.
Having worked in a nursing facility, I was able to work with wonderful physicians, nurses, medical technicians, and CNA’s, giving me first-hand experience with palliative care. I believe the number one contributing factor to treating a patient in the final few months of their life is the respect of autonomy. At the end of the day, it is their decision as to what goes into their body and how their approach to the medical treatments being done to them are performed. They should always be the person in charge of the decision-making process involved with their care. This is of course if they can are capable to give informed consent. If they are not able to provide consent, family and loved ones should hold that responsibility, as they know what is best for their loved one. Having witnessed an individual receive very high doses of pain medications, there are potential costly side effects that might be detrimental to the patient. I truly think life is beautiful, but if an individual is not coherently there, I believe they are ready for what is beyond life on this world - who ever their maker may be. Palliative care in the US needs provisions, as to where to allocate the resources and access to such care. I believe if the patient is receiving care with compassion and respect that aligns with their values and beliefs, then the proper care will follow. The elderly as a population is a growing population, in which through proper education and awareness we as a community can make the final days of our loved ones not a scary process but beautiful thing.
I have felt like I am part of a thrown away segment of the disabled population. I am 57. And therein is my failure in receiving proper and necessary health care. I have thru my Dr and even my ins co BCBS, been identified as a person who needs home health care. However I am not a senior nor am I ready for a nursing home. The diagnosis of CAD on top of uncontrolled diabetes 2, HBP, Familial Hypercholesterolemia and 7 family members before me who have died early of these same diseases. But I have the added bonus of Osteoarthritis and other damage to my spine which renders me unable to walk more than a few hundred steps per day. I am told by Medicare that I don't need help unless I pay for it myself. I live on my disability and that doesn't leave enough to pay for home health care. I can't even obtain a ride to a Dr. I wonder if palliative care could be for me?
Thank you.
Thank toy Doctor.😇
Dr. Ihrig, you might want to read Stephen Jenkinson’s book, “Die Wise.” He headed the home-based palliative care department in Canada’s largest hospital for five years. I am currently in palliative care in a Kaiser facility in California. Good title, yes, it’s about living, but also about some acceptance of the limits of being a human and both living a life informed by death as to it’s preciousness and ending a life knowing that life requires an ending just as it requires a beginning.
Amen!!
Thank you Dr. Timothy..... but still you didn't mention a bit about the definition of palliative care and how exactly it can be used to relieve pain and stress.... is it only psychological or it includes pharmacological and interventional techniques. Thanks again for your nice lecture😊
As he says we take care of the whole person, so we use every possible way to help. Drugs, psychology, therapists everything
Eid Mansy I agree. If palliative care has the same tools as the oncology department, where is the difference?
Most oncology departments incorporate palliative care as part of their service, but I know that's not what you were asking.
The different is the goal. Palliative care goal is comfort and fulfill patient's life wish. The 'standard' oncology goal is to cure cancer or to prolong the patient's 'life' as long as possible.
Bravo
Treat the whole patient, were did that concept go?
Melissa Rowan I remember when looking at the whole person is the only route to wellness
I believe I am facing this and I am at peace with what will be. How do I bring this up with my adult children who live in three different. They have an idea something is happening how do I bring the topic up? I want to leave this life in peace with no extensive care & as little drama as possible. I'll check back.
I hope you found a way to have this conversation with your adult children...and you have their support to live as fully to the end as you wish.
How do I get permission to show this video to my small group of chaplains? Is this possible?
Can you get IV fluids when dehydrated at home on palliative care?
Sounds great, I'm wondering if it helps for progressive Dementia patients?
It helps in every kind of diseases.
Embroider I pulled this video up because someone asked me if we looked into palliative care for my father. I had no idea what it was and pulled this video up. I'm so sorry to say I still don't quite know what it is. What's the difference between palliative care and hospice? I guess I will watch more videos
Pallative care is comfort care, symptom management while still actively being treated for said disease. Hospice service is comfort care with no further curative treatment. Its about quality vs quantity of life. If you have more question feel free to ask.
👏🏻👏🏻👏🏻🙏🙏🙏
Live longer? My late Dad declined fast when treatment was stopped. The cancer decides longevity.
i have Lou Gehrig's/ALS which is terminal. He never mentions it. ALOT of health professionals have never heard of it. hmmmmmm
Continuing the conversation at Dr. Tim's facebook page. Facebook / ihrigMD
Treat the patient, not the symptoms.
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I think palliative care doctors are ok as long as they don't try to force their will on patients. If a patient wants to take a vial of sodium barbitol that will shut down the body, then they should be given that choice.
That's suicide. Palliative care has nothing to do with suicide or killing patient.
The only thing I would add is that Jesus Christ and His Gospel need to be included in all care if we are to truly enjoy life to its fullest and find lasting meaning.
This is a myth of the church to control and take your money. The Bible is a storybook