tem. Many young physicians I have the privilege of meeting and teaching graduate without having been taught the basic skills of guiding and coun- seling seriously ill and dying people through the most difficult but nor- mal times of human life. I don’t think that’s their fault. I think it’s our fault as medical educators. Ironically, we still teach labor and delivery, prenatal care, and childbirth to every medical student — even though very few go on to deliver babies — but in a four- year curriculum, we teach 20 hours or less of palliative and hospice medi- cine — even though the large majority of physicians contribute to the care of seriously ill and dying patients.
Texas Medicine: What do you think about tools like POLST (Physician Orders for Life-Sustaining Treatment,
www.polst.org) and advance direc- tives, for which Texas is considering creating an electronic registry?
Dr. Byock: Texas has been on the forefront of a lot of this, grappling with some of the difficult ethical and systems issues that result in this pub- lic health crisis. Some doctors are very well versed and know a lot about the clinical use of the advance directive and POLST forms and how to engage in authentic shared decisionmaking with patients and families. But I don’t think the majority do, and there’s a lot of room for improvement both in un- dergraduate education and residency and fellowship training, but also in continuing education. I applaud TMA for calling attention to this. This is an area in which we know what best practices look like, and we know that much better care is associated with significantly lower costs because the more you plan and clarify achievable goals and the more you invest in co- ordination, in crisis prevention, and in early crisis management, the less time people spend in hospitals and ICUs (intensive care units). So we are the value equation.
Texas Medical Board appearance?
Pending
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