Dialogue Volume 13 Issue 1 2017 | Page 33

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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