Uncertainty, Decision-making And Team Work In High-tech Healthcare: Person-soulmindbody-hood & Relational Medicine

Description

The Relational Medicine project is growing. In 2014 we published our practice framework "Relational Medicine — Personalizing Modern Healthcare: The Practice of High-Tech Medicine As A RelationalAct". Building on this foundation, we now present a cutting-edge and fully developed single case recording analysis of consecutive encounter interactions in a dramatically accelerating life-and-death decision-making situation in the high-tech medical practice of Advanced Heart Failure during which practitioners, patient, and family face multiple uncertainties as the decision-making process unfolds and the patient's condition deteriorates. We show how a multi-professional team including a cardiologist, cardiac surgeon, critical care unit nurse and fellows discuss life-prolonging options with their patient and family. We make visible the essential roles of each multi-disciplinary team member in helping frame for the patient and family what is going on and the changing options while attending to the patient's PERSON-soul-mind-body-HOOD. In bringing different data, perspectives, and facets of understanding to bear, this book offers a novel approach to studying high-tech medical care grounded in Federica Raia's Relational Ontology framework of understanding everyday practice. Using a micro-ethnographic data analysis and a participatory research strategy, we unravel a heretofore unrecognized universe of practice themes and present suggestions for medical education and training aimed at continuous practice improvement. CONTENTS SHORT SUMMARY ACKNOWLEDGMENTS ABOUT THE AUTHORS CHAPTER 1. INTRODUCTION Introducing the Case The annual heart failure symposium A monthly lecture for the residents Organization of the book CHAPTER 2. CONCEPTUAL FRAMEWORK Breakdown of Familiarity Caring for the Other Framing Framing as Care for the Other Facing Uncertainty Research Methodology Participatory action research Starting with expert practitioners Moment-to-moment interaction analysis Meaning-making and being a certain kind of practitioner Ethnographic approach Iterative research model CHAPTER 3. FRAMING THE OPTIONS A Rollercoaster Evidence-Based Reasoning Framing from the Beginning Changing Conditions and Evolving Options Dealing with uncertainty Mr Spencer’s questions Framing Uncertainty: A First Discussion CHAPTER 4. INTERACTIONS WITH DOCTORS IN TRAINING Multiparty Conversation Overlaps and interruptions: Competition over care Creating Obstacles by Ignoring Uncertainties Reframing by Using Caring Power CHAPTER 5. THE ITERATIVE NATURE OF DECISION-MAKING Multiparty Perspectives — Building the Team December 29, Afternoon December 30 Questions, Ambiguities, and Explanations Projecting into the Future with Transplantation December 31 CHAPTER 6. INCREASING URGENCY Meeting the Surgeon On razor’s edge The VAD is in your future The “weekend effect” Urgency-Related Tension in the Team Backstage and Frontstage Communication Assigning agency Mr Spencer’s decision. No ghoulish options Mr Spencer’s doubt CHAPTER 7. TRANSITIONING FROM URGENCY TO EMERGENCY: THE ROLE OF THE EXISTENTIAL DIMENSION Professional Visions A Bridge to a Bridge to Transplantation Consenting for ECMO: “The nuclear option” Another Professional Vision in the Room Affordances in Teamwork CHAPTER 8. CONCLUSION Becoming a Team Learning to Care for the Other What Happened to Mr Spencer? Our Approach to Concluding This Book Exploring third options by focusing on moment-to-moment interactions Initiating relationalact-encounters openly and inclusively Creating safe spaces Framing evidence-based options Acknowledging uncertainty Availing oneself by listening deeply for questions and explanations Allowing silences Appreciating own mortality Embedding clock time in existential time Explicating role distributions Sharing decision-making Applying caring power Embracing inclusive “we” ness Fostering teamwork Attuning to multiparty conversation Observing the frontstage–backstage settings Noticing in multiactivity coexisting existential spaces Operating transformations Repairing communication acts Owning one’s professional vision REFERENCES INDEX