Palliative Care reflection

As in any new field, business or brand finding an appropriate and adequate name is essential. Palliative care is one of the fields that its name dose not grab people’s attention toward what it actually is. People usually follow one of the two categories if they hear palliative care either they have no knowledge at all regarding the field or others who link it to death and hospice (related somehow to death). This misunderstanding of the field is related to a few reasons which one of the most is that the name itself is lacking the idea of the field itself and the services the palliative care teams provide. This misunderstanding of the field is not only a patient related issue, but also some other healthcare providers do not know about it which makes so worse as they might not recommend such option to their patients in case it is needed.

I agree with changing the message of palliative care as it is the most area that a patient or family members will learn about this field before deciding to join. Doing so will provide those patients and families with the appropriate and good information to help them decide whether they would be joining or not. The message of palliative care as extra layer of support and giving hands to both patients and families and enhance and maximize their living experience regardless of age and illness. It is sad to think that people do not know about such valuable services due to lack of understanding of the field and other healthcare providers do not know how to define it. If other healthcare providers know the true meaning and services of palliative care, they would probably advise more of their patients to join a palliative care team to receive the extra car and support that other departments cannot provide to patients and families. Also, this true meaning of palliative care will be widely spread among society based on how people get educated about this field and if others have a real-life experience.

I also agree with enhancing the palliative care services to make it more available in different areas and hospitals and to reach out to larger number of the population by expanding the hours of care to 24hr/7days a week in person or virtually in home, home support, reduced overall costs, symptom management, trust, family and more. This will help patients and their families to have the best experience with palliative care and they would absolutely speak about how great it is to other friends and family, so how important and valuable the field will be known to the society.

On the other hand, I disagree with changing the name of the brand because if only the name got changed and nothing else, people will get to know eventually and same issues with current naming will be risen again. I think regardless of the name, the message and services are what matters the most as if any healthcare providers will be suggesting palliative care to a patient with the appropriate message or if patients and families will be educating themselves. As both patients and healthcare providers have different roles, I will not be choosing the same approach to palliative care’s for either. I think healthcare providers will be only giving the suggestion and recommendation of palliative care; however, patients are the ones who will be undergo the changes in their life if they decide to go to palliative care. Based on that, I think it is essential to have the appropriate message coming from the healthcare providers, and for the patients, it will be essential to enhance the actual experience to maximize the benefits and this will result in a positive view of palliative care. As reviews and real-life experiences speak for themselves, I think patients and their families will be leaving a positive overview of the field and more people will be happy to join and experience the great services palliative care offers. And for healthcare providers, I think it will be better to educate more about the services of palliative care by learning about the field more and go for actual site visits to have much better picture of the department so they can better offer this option to the patients. If more healthcare providers know about the field and leave a positive review to their patients, more patients will be joining palliative care.

US HealthCare System

The USA HealthCare System History

The middle of the twentieth century was the time where transition has occurred not only in the whole world (after world war II), but also in the healthcare field. Since before the beginning of that century and healthcare system was not regulated and there were not as many professionals and organizations that had taken any steps to improve it. Resources at that era were very limited (Hospitals, physicians and different health professions, technology, etc.), physicians practiced their careers from their homes, and patients used to pay their fees right out of their pockets as there was no such thing called health insurance.

The technology evolution was what made the spark in the healthcare system and rose the quality of healthcare and increased the ability to provide more for professionals and patients. Hospitals number increased as well as the services provided, and drugs industry came into light when the first drug destroying a disease was founded early 1900s. As more technology evolves, healthcare system also evolves. Currently, healthcare providers are able to help millions of people and treat them as needed, besides preventing and protecting from different diseases.

For the purpose of this assignment, I interviewed one of my friends who happened to be part of this transitions stage and see how our healthcare system evolved over time. He was born and raised in a small village Altoona, IA. Fortunately for him, his father was the physician of that village, so he had seen his father helping around a lot of people. His father did not work in a hospital; however, he had his own small clinic at his house where he treated his patients. Since he was the only physicians at that village, he was the first-person people call in case of any emergency, so he used to receive a lot of telephone calls (or people stop by his door) at nights. According to him, at that era, there was no health insurance, and most people pay their fees out of their pockets to his father which they were not that much at that time ($9-$20). Also, there was not any pharmacy or a pharmacist, however, his father used to deal with some resources outside of the village where he got some of the important medications for patients in need. He used to be around his dad a lot, so he would consider that as check ups (or visitation to a doctor). Since his father passed away, he always goes to his doctor for general check-ups every year. Thankfully, he is in a very good condition and health.

Nowadays, our healthcare system has raised to be one of the biggest and complicated field. The number of hospitals around us and the services they provide is out of our expectations, and so the number of physicians and healthcare providers. The number of pharmacies and pharmacist has tremendously increased in the past a few years as drug discovery/industry evolved. With all those increases, health insurance become a must in most schools and work-places. Hospitals emergency, and doctors’ visitations become pricier (at least $100) as the quality of the service has been the mission and the vision of our healthcare system. I think our healthcare system is better than ever as it is growing to cover more people who are in need.

Code of Ethics for Pharmacist

Code of Ethics for Pharmacist

As a student in one of the most professional areas “Pharmacy”, I believe in the importance of conducts and behaviors in such field. As a pharmacist I assist in using medication properly by individuals with various issues. Following such stated code is one major responsibility as a pharmacist, and fundamental for success. I believe such principals is served as guidance to pharmacist for their relationships within the health professional field, patients and society.

I.                 A pharmacist respects the confidentiality of an individual
Helping others is a gift and it does not matter what you provide to them as long as you keep their privacy as your main concern. Pharmacists have the moral pressure to keep their patients’ private information in complete secret and have no right to break such rule or obligation, in addition, to respecting the trust of individuals seeking help.

II.                A pharmacist respects the needs of any individuals and provide the best care and good for them.
Pharmacists are the link between doctors (healthcare professions) and individuals. In a way to respect such connection, a pharmacist must provide the best care needed, and help giving the best treatments to patients based on their needs. Patient needs must be the priority of any pharmacist.

III.              A pharmacist must be honest and avoid any act of dishonesty or cheating.
Pharmacist has the duty to be honest and tell the truth and talk in professional way to those who in needs. Gaining trust is not a one-time thing, however, it is a process, so pharmacists must do their best and complete their full duties to gain trust from their patients and their community as they are providing their helping hands, caring, and support.

A pharmacist must respect colleagues and other health professions and gives them credits on their work.
Not only it is important to be honest with patients and build trust, but also, that expands to reach to pharmacist’s colleagues and any other individuals in any health profession field. The honesty in work and not cheating in different assessments is a must to gain trust from others, in addition to giving credits to who deserves and not stealing their work, taking into consideration that each individual will have their own beliefs and way of dealing and caring for patients. 

Disease Trajectory

In class, we covered three different trajectories of death: Cancer, Organs failure, or Dementia. If I had to choose between the three of those trajectories, I would choose the death of cancer. Some of the reasons that I would choose this death path are it will cost less pain to my loved-ones either physically or mentally as organ failure might lead to my family giving me pieces of themselves trying to save me, and dementia will lead me to not recognize who they are and appreciate what they are doing for me. However, in cancer, even though they will go through a lot of mental pain, they will be supporting me as I am fighting the cancer and I will be still recognizing them and be with them as who I am. Finally, once the death come to the way, my family and loved ones would know me as a fighter because as I know myself that I will never give up to a disease and I will be fighting to the end.

On the other hand, I would be mostly afraid of getting organ failure. This is because organ failure will give me and my loved ones the hope that I might survive and live longer, but we all do not realize how fast the reduction in health and another organ will occur. So, this path will give a lot of hope before it breaks everyone by my death in the end. Also, this death trajectory might lead one of my family and loved ones to decide to donate/transplant an organ to me (or a piece of themselves) which will give us a little hope for just a short period before the drop happens again. So, I would rather they keep their organs and do not go through so much pain when in the end I would not benefit much out of it even though I understand they are trying to support and help, and they want me to live. In this case, I would be more than happy to live shorter and know they are healthier and do not have to go through pain. Even if none of my family will be the one who sacrifice or donate and somebody else (unknown), I would rather be happy with those people give their organs to other patients who have higher chance of benefiting of the transplant than me.

In conclusion, for all the reasons mentioned above, if I had to choose, I would choose to die of cancer, and I would be more afraid of passing away of organ failure.

Advance Directives Planning

As I was filling and completing my advance directives document, the idea of how to approach my father, who I chose as my agent, did not go away from my mind. Since we live thousands of miles away from each other, I could not think of any better way to approach him but to send him the document with a brief message telling him what is the document is about, and give him a couple of days to think about it as he pleased and then approach me to talk about my document (healthcare needs and goals) in detail. We video called each other with better understanding of the goal of my document, so we both focus on my healthcare goals by keeping the emotional part of a father-son relationship aside. I can sense from him as a father that he was not expecting to have such conversation with me, but he understands completely the meaning and the goal of my move. He did not have any questions about my advanced illness or care, however; his only concern was that of what I wish to do with my body after my death. As I wish to be an organ donor if possible, he wanted to perform the Islamic burial tradition. However, I explained to him my motive to do so which is to help others and save lives if possible, he respected and accepted my wish.

The most challenging aspect of completing my advance directives was approaching my father as my agent to hold my will. Aside from knowing that he will accept and trust my wishes, it was very difficult to reach him with such topic because we lost my brother nine years ago. I did not want him to feel sad and reopen the door to the past, but I know he is the only one I can trust with my will and wishes. After completing the process of my future planning, I will definitely recommend my friends and patients to follow through and do the process and complete their advance directives for multiple reasons. First, having such informative planning will help their families and healthcare providers to choose the best treatment based on their interests, so it will reduce the pressure on the family and friends to take such decisions. Second, thinking in your healthcare plans in the future and who you want to trust to be your agent, will help you a lot in your current life-time as I was noticing what is important to me, who I can trust in difficult and emergency times, and what I want to do before I reach to such stage where I cannot be normal. Finally, they will know the path they most likely will go through after they reach a stage where they cannot realize what are their surroundings because they already wrote their plans ahead of time. Doing this document brings a whole new perspective to life and new way of looking at yourself.

A Pharmacist

Patient-pharmacist (or any other healthcare profession) is an essential encounter in the smallest level possible. This means every single detail a patient gives to the healthcare providers; it might make a huge different in the course of treatment. On the other hand, when patient encounters a healthcare provider; the interaction will be more important to the patient on the microscopic level, so healthcare providers have to be more aware of themselves during the interaction as all details would be remembered by the patient. I had a bad experience myself when I visited a dentist last year. As a new walk in patient, I gave the dentist a call before I go to make an appointment and to ask whether they accept my insurance or not. As in the phone they mentioned that they accept my insurance, so I moved forward and made the appointment. When I went for my appointment and I handed my insurance, they mentioned that they do not accept my insurance. (in fact, they did, but the lady sitting there did not bother to take the extra time to confirm as they just start dealing with this insurance company). I was explaining that I talked to X person and he said you accept my insurance, and they mentioned that they do not accept. Thankfully, by that time, the manager passed by and asked what the issue and he is mentioned that they do accept the insurance as they just added this insurance company. Once I went in to meet with the dentist and finish the procedure I came for, we briefly talked about estimated cost I will end up paying after the insurance approval, and based on this information, I agreed to move forward with the procedure. However, after we finished and I went to pay, there was a huge charge double than the price we talked about. I was shocked so I went to ask about what happened, but all what they said that there was some complications happened during my procedure (I do not know what sort of complications, but all what they know and mentioned was “some complications”). This was a huge inconvenient and I felt as I am used. I think by putting just some extra work and concerns, they would have gained me as a person/patient/costumer and I would have recommended them to others, but with my experience with them, this of course will not happen. I think putting just some extra time to explain, reach to the patient and give the full information needed would make a huge difference and avoid any misunderstanding or inconvenience.

Last Day Before I Die

It is always hard to hear or read sad and painful stories about people suffering and passing away because of an illness or any other reason. Even if those people do not relate to us, we tend to let go of our emotions and tears. However, I believe most of us have not put ourselves in such situations and how we are going to react, do, or say. I think such way of thinking which is to put yourself in a X situation (X: can be any situation in life e.g. illness, car crash, or even being a pharmacist) is an important way to prepare you for any scenarios you might experience in real-life. 

If I have been suffering from a serious illness that might take away my life such as Myeloid Leukemia, I would like to know more about the disease, chances of getting rid of it, and any possibilities that might occur based on my body and my body’s system. If the course of treatment with this 10% chance of improving a tiny bit, I would rather choose it. However, if the medical team already have done everything they could and there is nothing more can be done, then I would have to accept the fact that the life I was given has come to an end.

If I could have ONE more day, I would choose to spend this day with my parents, siblings and lovely grandmother. I would be looking at my mum and be laughing, and I would be annoying and get annoyed by my siblings as we love to annoy each other in a way that we all enjoy it and have fun together. I would be looking at my father’s eyes and see how much care and love he is hiding to every single one of us in the family. And I would be dancing with my grandmother and hearing her singing for me as she always doses whenever she sees me (especially when I go home sometimes during summer). In the end, I would like to hear a humbled prayer from mum, dad, and grandmother as they always have been the whole world to me!

Team Work

When I think of working in a team, I always think of brining different values, skills, strengths and perspectives to the table. Based on this, I would always prefer to work in a Multidisciplinary team. Multidisciplinary team in definition means that people from different disciplines working together that each one of them brings their own discipline (knowledge of their discipline) into the whole team benefit (work or project) to reach a goal. The reasons I will choose Multidisciplinary team are different disciplines might approach results differently which will widen the point of view or views, so more ideas will come to light. Also, different disciplines have their own knowledge which will help in providing new and might be better idea in comparison in working in only one disciplinary team. Finally, multidisciplinary team is an opportunity to everyone to benefit that means people within the group itself will benefit from each other and learn from each other, in addition, the group results might benefit the outside world, so everyone is benefiting (e.g. working in a multi healthcare team will benefit the team itself to learn from each other, and will benefit patients).

Working in a team is not always perfect as described in the previous paragraph, however; depending on the team members, the experience of working in a team will vary. Some team members will be easy to deal with them while other might be hard. I think it will be easy if you work with members that understand the values of working in a team and coordinate well. Working in a team requires a lot of skills, values and discipline, so it would be easier to work with a person who acknowledges the importance in working in a team as well as respecting all members, their ideas, and do not underestimate the value of any member. In addition to that, members should have good communication skills, so it would be easier for everyone to understand and benefit. On the other hand, I think it will be hard to work in a person who thinks that s/he the only good person in the group, so dose not show respect to members of the group. In addition to respect, I think it will be hard to work with a person who dose not listen to others or communicate well with the team.

Based on my experience in working with groups, I have experienced working with a member who is hard to deal with as he was always silent, did not share his ideas, and did not coordinate with the whole teams as he was doing his work just by himself. I first tried to approach him personally and talk to him as he is doing great job by himself and how we can put that with the whole group work. Then, I tried slowly to ask him to talk (at least with me) to share his ideas when applicable. Thankfully, he started to talk with us (all as group) and shared a lot of his ideas. I think sometimes we will find a group member who is hard to deal with, but with respect to them and to others, we should try to approach them based on their personalities and try to come into an agreement all, so the whole team function well.

Death and Social Media Existence

I honestly have not thought of what will happen to any of my stuff after my death, and my social medial presence is one of them. It is difficult to imagine that one day I will be transforming from this world to another one leaving all my things behind. I am not saying this in a greediness way, but it is just I am wondering of what will happen, especially, if I pass away while I am here studying abroad away from my home and family.

Regardless of what I would like to happen to all my other things, I do not want my social media existence to be available after my death. As what I know about Facebook, my profile would be still available for people to see what I have posted before, but it will mention in the top of the profile that this person is no longer alive by writing “remembering”. Even though I was that person who owned that profile, but I do not want any of my family, relatives, or friends to feel sad/low every time they cross the account. I remember when my brother passed away nine years ago, it was written “remembering” on the top of his Facebook profile and that used to bring all the memories we had and put me in a low mood for a while. Of course it was nice that Facebook reminded me of my brother and all the memorize we had since we just first came to this world, however; it used to put me in sad mood for a long time that I do not feel like worth living without him. I still love my brother and remember him and visit his grave every time I go back my home, but this dose not mean I would like to keep feel the same way every time I cross his profile. So, I do not think the social media existence is the best way to remember him. I always pray for him and include him in any of my prayers and I think that worth more than seeing his account in Facebook.

Thankfully, I do not have a lot of accounts in social media, so not many platforms that I am present in that people might cross me a lot in them. I would like all those accounts to be closed and deleted, and I do not want anyone to manage them because I do not have anything to be managed as for now. In addition, in case someone has to take over the accounts, I would like this person to be my father and the only thing I would ask him to do is to clear everything in the account and close it. As I mentioned above, the story of my brother has brought to my attention that I do not want people to feel sad for any reason if they come cross my accounts after my death. Again, this dose not mean they do not remember me, but I do not think social media accounts are the best way to remember someone. Prayers and photo albums that you can see every once in awhile are the best ways to remember someone, in my opinion. For about three years after my brother passed away, I used to gather his friends and my friends and some family members in the same day he passed away, and we used to do different prayers and share some stories and remember him as still a loved one, a loved soul that flying within and around us at that time.

Pharmacy-Pharmacist

Pharmacist-Patient Interaction

Pharmacist like many other health professionals will encounter a lot of patients along their journeys starting from their school times and during their career. They will meet patients who are somehow in good conditions, critical conditions, or patients with serious illness. Communication between healthcare providers and any patient is very essential in delivering the best care. Sometimes even if we are about to deliver bad news to patients, our way of communicating that news might help reduce the intensity of the situation. A pharmacist should approach all patients in a very respectful way and treat them all as his or her top priority. For patients with serious illness, it should be taken into consideration their pain and sufferers they are dealing most of their lifetime.

To establish a better interaction between a pharmacist and a seriously ill patient, a pharmacist should first know the patient and their medical and social situation and meet at a convenient place to the patient (E.g. quite place with no distractions). Also, a pharmacist should not deliver any information until the patient is ready. Once the patient is ready, a pharmacist should establish a smooth way in delivering any news and be honest and know the patient level of understanding about their conditions. The news should be delivered in a language that the patient can understand easily (So, no big medical words). Different patients will react differently to the same news, so a pharmacist must be ready to understand patient’s emotions, so the choice of words is essential in this situation. In addition, a pharmacist should respect patient’s emotions and support them, and try to help them exploring their feelings and might provide any kind of help needed. For example, a pharmacist could say “With everything that has happened, this must be difficult for you and I wish I can change it, but our team is here to help you and support you”. This statement including understating of patient’s emotions, responding to them, and supporting. I think the best way for a pharmacist to deal with different situations is to imagine different scenarios with different reactions from patients and choose the best way to react to each one of them before the real meeting. I know reality would be much harder than the imagination, but for me, I think it is the best way to prepare for such interactions.

This is also applicable if you meet with a patient who has already received bad news and not easily able to process them. A pharmacist should know the patients and their situation, approach those patients respectfully and meet with them in a comfortable place. Establish a connection by knowing the feelings of the patient, understanding what they are going through, respecting their feelings and reactions, and supporting them. If we only deliver facts and information to patients, they will be overload and might not care about their own health anymore. Using phrases like “This can be overwhelming for many people, but we can try to help pass this situation together” would be a good approach to patient’s feelings and emotions. Patients will be frustrating and angry if a healthcare provider used the phrase “I understand…” because the reality says that healthcare providers do not understand what the patient’s is going through unless they are at the same exact situation as the patient (which is impossible), so it is better to avoid this phrase. Instead, we can use the phrase “With everything that has happened, I can see why you are frustrated”. This phrase shows that we understand from our perspective that the situation is very hard on the patient, but we cannot imagine how much of a pain they are going through. Lastly, it would be much appreciated if a pharmacist provides level of help and support within their ability and easily acceptable by the patient. For instance, a pharmacist must not say a statement like “I know this is difficult, but I will be by your side 24/7 and help you with anything you want”, but rather saying “This is must be very difficult, but our team is here to help you and support you as needed and we will go through this together”. Even if this statement is somehow general, but it provides a better level of support to the patient, and it will be easier for patients to accept in comparison to the firs one.

In addition to those verbal communications between a pharmacist and a patient, non-verbal communications are also at the same level of importance as the verbal ones. For example, a patient will be more comfortable dealing with a pharmacist who listens carefully to their needs and do not interrupt their talking. Also, eye contact between the two is very important in keeping the conversation running because if the pharmacist is not given his full attention, the patient might not be interest to share information and their feelings, so their condition might worsen due to the lack of interest from the ignorant pharmacist. So, it is always appreciated from patients if their pharmacist listens to them, responding to them, have the appropriate expression to the situation, feeling relaxed and have a good posture, keeping a good eye contact with the patient, and sits at the same level as the patient so the patient feels comfortable and not overpowered by the pharmacist. These all non-verbal communication skills that a pharmacist should have in addition to the verbal ones, so a better care is delivered to patients.

Euthanasia

Euthanasia and Physician Assist in Dying

I am going to start my reflection with mentioning two important points came to me when we discussed these topics the first time in class. First, it is very hard to imagine myself or someone I love in such situations which makes it difficult to reach to a solution or conclusion. In addition, I think the power of such topic that it is very controversial because it deals with pain, suicide, death, and helping someone with their decision to die. So, no matter how hard people try, a one conclusion won’t be reached, and no-one will have a complete agreement with either direction. I know this is obvious, however; when it comes to healthcare, I always think there should be clear solutions to every problem to serve the maximum happiness for patients and healthcare providers. However, this is not true even though we have the best technologies compare to any era. Technology has helped a lot to improve in delivering healthcare, but when it comes to the end of life stage, technology has no role in deciding weather to die or not.

I was a part of Con Euthanasia and I still do agree with the conclusion we reached after the debate. My team and I concluded that euthanasia should not be legalized as it is in conflict with healthcare providers obligation of do-no-harm, the total suffering definition of euthanasia is not precise with every single patients as suffering is completely different among humans (could be financially, socially, health and so on), we do not know the entire story behind the patient’s decision to euthanize and there might be other ways we still can help them. Nowadays, palliative care and hospice have become a major part of healthcare and patients from any stage could be involved under such care that might lead them to alter their decisions along the way. With the presence of this field, I do not think euthanasia should be legalized as palliative care will try to help the patients and the family to go through this stage of suffering (due to terminal illness, developed diseases). Also, this will help healthcare providers (especially doctors) of not making a hard decision of prescribing and giving a medication to help patient die.

Moreover, I think physician assist in dying also like euthanasia and I would not agree with it for the same reasons. My grandfather was once places in palliative care before he passed away four years ago. He was completely ill and cannot live a second without machines. As he was going through this, and we all as a family, not once he mentioned he want to die, or any family member recommend we put him into death peacefully instead of the pain he was having at that time. A few months later, he passed away because not even the machines or doctor were able to help. Death is an end of our life and it will come to us sooner or later, however, if we decide to take our own life or the life of loved-one earlier, I think this is in no difference with committing suicide. As a believer, the life we were given is not in our hands and we cannot decide such huge decision to take it away from ourselves because of illness or pain. I think this pain and suffer is part of life and we must deal with it (and so our loved ones and family) as we go through those stages.

One last thing, I also believer there is solution to any problem or issue in this world, and if people around me and I do not know the solution of X-problem, someone else might know (in healthcare, there might be a doctor in different part of the world who knows a treatment for a disease that you do not know, or something new might be developed and change my end-of-life stage and I recover).

Currently, we live in a pandemic of the spread of COVID- 19, and I do not think patients can choose to die if they have this virus and any other health issues that put them in a lot of pain and suffer as there is no treatment yet to this virus, but a lot of trials have been going through study so far. So, if a patient decides to die, and tomorrow a treatment was discovered, I think the family of that person will regret the decision of the patient (or if they helped taking that decision). 

In conclusion, I do not agree with euthanasia and physician assist in dying as I mentioned above. Again, it is very hard to decide and reach to this conclusion if I am out of the circle, however, this is what I believe in and I had an experience once with my grandfather, and I think I would do the same always.