Narrative Matters: On Our Reading List

Editor's note: "Narrative Matters: On Our Reading List" is a monthly roundup where we share some of the most compelling health care narratives driving the news and conversation in recent weeks.

What Matters Most At The End Of Life

One reason doctors and patients may disagree on "what's best" when it comes to end-of-life care is that doctors may not be trained, or make time, for necessary conversations about what is most important to patients. In The Washington Post, Ravi Parikh, a resident in internal medicine and primary care at Brigham and Women's Hospital, writes about a patient encounter that motivated him to learn more about how to start these conversations, and thus provide better care at the end of his patient's life.

New Medicare rules that will allow doctors to be reimbursed for discussing end-of-life preferences with patients, and initiatives like The Conversation Project can help physicians figure out where to start, Parikh notes. Asking his patient what mattered to him most, "opened my eyes to how little I'd been listening," he writes.

"End-of-life discussions are opportunities to learn more, to start a conversation that we as doctors have been missing out on for quite a while. Once we listen enough to learn, maybe those 'goals of care' discussions will start focusing on the goals of the patient, not the doctor."

It's Time To Teach Physicians About Drug Misuse And Addiction

In "The Patient You Least Want To See," published in the Journal of the American Medical Association, Jonathan H. Chen writes about his struggles in caring for patients with drug addictions and drug-seeking behaviors. Recounting stories from patients he cared for over the course of his training, Chen paints a picture of a disorganized, inconsistent approach to pain management, on one hand, and addiction management, on the other, throughout the hospital. The end result is dangerous for patients, and confusing to physicians in training.

"While many clinical topics compete for education priority, prescription drug misuse and addiction is one that an inadequately trained medical community will routinely contribute to, if not overtly cause," Chen writes. "Facing this is challenging, but I recall one of my medical school attending's teachings: The patient you least want to see is probably the one who needs you the most."

The Real Lives Of Heroin Addicts

Drug genre photography has tended to sensationalize heroin use, depicting it as exotic, sexual, primitive, and dangerous to society, according to Aaron Goodman, a member of the journalism and communication studies faculty at Kwantlen Polytechnic University in British Columbia. For more than a year, Goodman followed three individuals who were addicted to heroin and enrolled in a heroin-assisted clinical study and treatment program, and documented their lives inside and outside of the clinic in a photo essay for The Conversation. [Editor's note: One image in the link features nudity]. Goodman made a conscious attempt to avoid sensationalizing and "othering" the drug users; additionally, he showed his photos to his subjects before publishing and included their commentary on each photo along with the essay.

"I just hope the people see me in this photo — that I'm a striving, struggling drug addict. That I'm trying to better my life," writes one of the individuals in a caption on her photo. Goodman hopes to bring attention to heroin-assisted treatment, in which users who haven't responded to other forms of treatment receive pharmacological heroin in a clinical setting.

"While these programs have long been recognized as scientifically sound and cost-saving in countries like Switzerland, the Netherlands, and Denmark, heroin-assisted treatment is only beginning to be offered in North America," Goodman writes.

Talking About Miscarriage

In "A Year of Loss," freelance writer Jessica Strelitz shares her experiences with multiple miscarriages, and the importance of finding a community of others with similar tragic experiences. In the instances of her miscarriages, doctors were never able to ascertain why they occurred, Strelitz explains in an essay for Arlington Magazine.

"It's important for people to know they're not alone and that despite the woeful lack of research and understanding around the issue, just how common [miscarriage] actually is, and that there is hope beyond the profound sadness of D&Cs and missing heartbeats," Strelitz wrote to others like her on a private Facebook parenting page.

Making Informed Consent An Informed Choice

In the April Narrative Matters essay, Cindy Brach, a senior health policy researcher at the Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality (AHRQ), writes about being pressured to consent to her father's treatment after a stroke is suspected, without fully understanding the risks of the recommended treatment.

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