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Article review by Beginning Drake &#8211 Writing sample 5/2008 [email&#160protected] Lieff, J. (1982). Eight primary explanations why doctors fear the seniors, chronic illness, and dying. The Journal of Transpersonal Psychology, 14(1), 47-60. Jonathan Lieff, author have to know ,, holds a b – – -.A. from Yale College along with an M.D. from Harvard Medical College, and contains earned board certification using the American Board of Psychiatry (Ages Health Services Corporation. 1996). Once the article was printed in 1982, Lieff acquired services for seniors, handicapped, and crictally ill patients in regards to the the Boston Housing Authority, aided living facilities, and hospitals. He’d also offered as Director of Geriatric Fellowship at Boston College and Chief of Geriatrics at Lemuel Shattuck Hospital, a Tufts College Facility. During this paper, I summarize the data and offer comments about selected aspects, identify some relevant changes which have happened because the article was printed, and suggest locations where additional research findings is required in understanding the current condition of healthcare in regards to the problems elevated. Article Summary Lieff described recent (during publication) research findings that indicated &#8220widespread and well-documented prejudice&#8221 (p. 47) against seniors and crictally ill patients, which recommended prejudice and avoidance behaviors were fostered in American medical schools. Lieff also documented advantages of &#169 Beginning Drake, 2008 1 mental support for dying patients then identified and discussed eight why you should explain the &#8220fear&#8221 (p. 47) he believed could explain doctors’ behaviors toward these patients.

Plenty of his explanations reflected spiritually related issues that he believed were in the finish within the issue. Lieff (1982) did understand that some doctors, mostly not physicians (i.e. nurses, social workers, therapists, plus a handful of physicians who find personal reward in offering elder-care), countered standard by providing more efficient services for that seniors. After discussing the relevance within the spiritual needs within the dying, Lieff (1982) concluded by positing the advantages of a increased professional focus on the &#8220psychological and spiritual factors&#8221 (p. 59) within the final stage of existence. Critical Glare The dominant purpose have to know , appears to get at convince your potential customers that Western doctors (particularly, American doctors) weren’t ready to own emotional and spiritual needs in the sufferers who had been dying, and additional, that spiritual training must be incorporated as being a standard element of medical practicing doctors. All what can cause fear that Lieff discussed reflected mental or spiritual issues contemplation on other adding factors was noticeably missing. Although Lieff offered persuasive ideas to explain why doctors might &#8220fear&#8221 chronically ill and terminal patients, plenty of his descriptions of doctors’ attitudes and encounters incorporated neither research references nor acknowledgement the statements were his opinions&#8212presumably according to his encounters available, but opinions, nevertheless.

Incorporated within this are assertions that lots of &#169 Beginning Drake, 2008 2 doctors didn’t recognize a persons possiblity to transcend physical limitations and uncover personal fulfillment, that doctors lacked sources to locate philosophical insights into the aim of dying along with the dying process, that numerous doctors weren’t ready to handle impact that belief or encounters had around the strength of treatment, which society had given doctors &#8220a type of priestly status&#8221 (p. 58). Acknowledging his comments as opinions or personal observations then explaining his reasoning might have provided an chance to help a skeptical readers to agreement. By offering neither research findings nor personal reasoning, Lieff potentially elevated the reader’s capacity his arguments. Numerous statements also appear to share Lieff’s own frustration in accepting the terms with dying and dying, especially within American society. For instance, Patients additionally for their families generally utilize the physician for strategies to these problems. The conventional physician could be no better ready to take proper proper proper care of their particular seniors parents and granny and grand father. But they’re expected magically to supply solutions (p. 55). Theorists&#8230attempt to incorporate the termination of existence as being a mental developmental stage. What mental development results in dying? (p. 56). Within the medical system that lacks a non secular reason for selection, it is not acceptable to die with no medical cause. This can be among a number of ways the doctor is produced helpless within the system that’s structured to assist him hide this feeling of helplessness (p. 58). Statements like these contributed a mental quality for that article that might increase the persuasiveness within the argument for several readers, however that others will uncover inappropriate within the scholarly article. Upon recognizing this undertone of non-public frustration, your potential customers has provocke question the objectivity, &#169 Beginning Drake, 2008 3 so the validity, within the overall argument. This, while using insufficient support for almost all the assertions made, undermines the possibility advantage of Lieff’s presentation within the issues. Further Research Lieff supported Kastenbum’s approaches for offering patient-oriented standards, but expressed reservations regarding the whether individuals recommendations might be effectively implemented within the u . s . states. Lieff (1982) recommended that hospices, that have been rare within the U.S. in 1982&#8212only about 1,500 programs existed by 1985 (National Hospice and Palliative Care Organization, n.d.)&#8212might give a acceptable model for finish-of-existence care. Changes have happened in American society which have dramatically altered the conditions that existed when Lieff authored this information. Some pivotal ones that directly affected healthcare are, 1. In 1983, Medicare started dealing with cover hospice take proper proper care of qualified patients (von Guten Ferris, 2002). 2. In 1997, the American Board of Psychiatry and Neurology, Corporation. approved Geriatric Psychiatry just as one official subspecialty (n.d.). 3. Around 2006, the American Board of Medical Specialties (ABMS) approved the subspecialty of Hospice and Palliative Medicine (HPM) (American Board of Medical Specialties, 2006). (Palliative care provides treatment to help relieve discomfort and signs and signs and signs and symptoms without treating the main cause.) &#169 Beginning Drake, 2008 4 4. Using the National Hospice and Palliative Care Organization (2007), around 2006 the amount of hospice programs within the U.S. had grown to 4,500, serving an believed 1.3 million patients, and lots of one-third of deaths inside the u . s . states . Claims that year happened since the patient was receiving hospice care. 5. These changes report that a substantial shift has happened, or even is going on, in the manner the medical community views seniors and crictally ill patients, nonetheless they don’t reveal the building blocks or reason for the progres. The study as mentioned by Lieff (1982) ought to be revalidated, especially regarding whether prejudicial attitudes and avoidance behaviors remain proven in medical schools certainly one of practicing physicians, together with what mental treatment solutions receive to seniors and crictally ill patients. It might be also appropriate to consider additional conditions, aside from the &#8220fear&#8221 that Lieff identified, that can result in individuals attitudes and behaviors. Lieff’s comments also elevated other conditions that suggest further research options. He noted that nurses, social workers, and therapists were leading the techniques by providing better take proper care of the seniors. How do their way of treating and reaching patients vary from physicians’? Internet site different attitudes about patients or perspectives on existence and dying? What’s the method of getting any variations? After they learned the process and attitudes within the formal setting, how were individuals alternatives trained? Are individuals methods transferable to &#169 Beginning Drake, 2008 5 physician training, therefore, has there been progress in incorporating individuals changes into medical schools? How do patients additionally for their families start to see the concern the nurses, etc. provide rather from the concern that’s supplied by physicians? Do these patients additionally for their families communicate their feelings with others, therefore, has it effected any difference in expectations in individuals others? How do doctors react to they&#8212are they supportive, obstructive, or neutral? What effects do these practioners experience, and exactly how does affecting their need to keep employing their methods? And, clearly, the quantity of physicians are entering the brand-new subspecialties which are targeted at treating these patients? Lieff recommended that physicians should receive more spiritual training, according to his assessment in the &#8220fears.&#8221 It might be appropriate to conduct current research to uncover whether his assessments are correct regarding today’s physicians for instance, whether doctors believe there’s a &#8220priestly status&#8221 nowadays and they are ill prepared ethically and morally &#8220beyond obeisance to academic and guild organizations&#8221, whether dying certificate needs ensure they are feel &#8220helpless&#8221, and whether or not they refer patients to specialists for help when controling &#8220problems of meaning and purpose (pp. 54, 58).&#8221 Research into doctors’ opinions about including spiritual orientation in medical training may be important, then when they offer the idea, what methods they’d consider appropriate for working the data and receiving the training. &#169 Beginning Drake, 2008 6 This information raises issues and options which are rife with questions worth exploring additional examination should rapidly raise research options beyond individuals identified above. Conclusion Lieff presented convincing research that chronically ill and terminal patients need mental support, yet many American doctors exhibited avoidance behaviors toward them noisy . 1980s. It seems, though, that Lieff’s primary aim ended up being persuade your potential customers that spiritual training must be incorporated in American medical training. Because they focused mainly on spiritual issues, positioned opinions as details, and communicated an undercurrent of frustration, the details are vulnerable to being discounted as fallacious rather to become recognized just as one objective, scholarly control over the finest professional concern. Several 4th in the century is lengthy gone because the article was printed, plus that point, significant changes have happened within the health care industry affecting how crictally ill folks are treated within the U.S. Because of the growing population within the seniors along with the significance within the concerns elevated by Lieff, current research into medical training practices along with the need and appropriate goals for including spiritual learning medical education curricula appears both appropriate and imperative that you ensuring a top quality of compassionate and efficient care will most likely be accessible to individuals who’re reaching the final outcome in the existence. &#169 Beginning Drake, 2008 7 References Ages Health Services Corporation. (1996). Form 10-KSB/A-1 Annual Report Pursuant to Section 13 or 15(d) within the Securities Exchange Act of 1934. Retrieved May 2, 2008, from internet.secinfo.com&#8212drP9x.81v.htm American Board of Medical Specialties. (2006). News release: ABMS establishes niche certificate in hospice and palliative medicine. Retrieved April 30, 2008, from internet.nhpco.org/i4a/pages/index.cfm?pageid=5072 American Board of Psychiatry and Neurology, Corporation. (n.d.). Initial certification within the subspecialty of Geriatric Psychiatry. Retrieved April 30, 2008, from internet.abpn.com/gp.htm Lieff, J. (1982). Eight primary explanations why doctors fear the seniors, chronic illness, and dying. The Journal of Transpersonal Psychology, 14(1), 47-60. National Hospice and Palliative Care Organization (NHPCO). (n.d.). Increase in U.S. hospice programs: 1974 to 2006. Retrieved May 5, 2008, from internet.nhpco.org/files/public/Statistics_Research/NHPCO_details-and-figures_Nov2007.pdf National Hospice and Palliative Care Organization (NHPCO). (2007). NHPCO details and figures: Hospice care within the u . s . states. Retrieved April 30, 2008, from internet.nhpco.org/files/public/Statistics_Research/NHPCO_details-and-figures_Nov2007.pdf von Gunten, C. F. Ferris, F. D. (2002). CAPC manual: Anything you wanted to discover creating a palliative care program but were afraid to check out. Retrieved May 4, 2008, from 64.85.16.230/educate/content/rationale/ushospicegrowth.html &#169 Beginning Drake, 2008

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