Started Family Medicine this week (my last clerkship!) and very much agree with the philosophy, probably more than the Internal Medicine approach: that you must take the patient in context. That much of what we consider “health” doesn’t fit within the conventional boundaries of medicine, and that a person’s environment greatly affects his or her health. A couple of thoughts from the introductory lectures, one by a patient advocate on Advance (not Advanced!) Directives:

• On the term “life support,” as in: We would have to place your dying father on life support or else he will die tonight: We should call it “artificial organ support,” not life support. Life is something that we define as people–and all “life support” does is keep the organs in the body working longer.
• On making sure everyone has an advance directive: Maybe it’s a bit morbid, but what if on Thanksgiving or some family holiday, everyone brought out papers and wrote an AD? Then everyone in the family would have their wishes known, and there’d be less fighting later.
• Did you know you can write people out of an Advance Directive? Say you have a child who hasn’t been around for a long time, or a trouble-maker in the family–you can specifically mention in your directive that you do not want that person to take part in health care decisions for you. (I hadn’t considered this as a possibility.) ( Some info on ADs. )
• On “Do Not Resuscitate”: In Georgia (and it seems, slowly spreading elsewhere), health care may be switching to the term “Allow Natural Death,” trying to make it known that death is a normal part of life, and that it cannot (and perhaps should not) be fought at any cost.

And finally, via the wonderful Gooznews :

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