Eight Reasons Why Doctors Fear the Elderly, Chronic Illness, and Death by Jonathan Lieff - Article Example

Journal Review JOURNAL REVIEW Introduction The of the above article is Jonathan Lieff who got a Bachelor of Arts from Yale College, as well as attending Harvard Medical College and being awarded an M.D. he also has board certification that he was given by the American Psychiatry Board. The article above underwent publishing in 1982, at which point Jonathan Lieff had already developed services for those patients who were terminally ill, those who were handicapped, and the elderly in connection with hospitals, nursing homes, and the Boston Housing Authority. Lieff has also served as Chief of Geriatrics at Tuft University’s Lemuel Shattuck Hospital facility and a director at Boston University’s Geriatric Fellowship. In this paper, there will be a summary of the article, as well as comments regarding various selected aspects, identification of various changes, which are relevant and have occurred since the publishing of the article. In addition, make suggestions for the areas that additional research findings would aid in the comprehension of the current state of psychological medical care with regards to the issues brought up. Summary of the Article The author described research findings made at the time the article was published, which were indicative of well-documented and widespread prejudice, as well as avoidance (Lieff, 1982). The author also suggested that American Medical Schools were found culpable of fostering this behavior. The article also detailed research findings on the benefits that dying people received through psychological support. The fear of dying patients was explained through eight reasons, which Lieff believed explained the attitudes towards the patients by doctors and other health care providers (Lieff, 1982). Majority of these reasons deferred to problems that were related to spirituality, which the author contended were the root of the problem. He also indicated that medical professionals like social workers, nurses, and therapists who get professional and personal satisfaction from caring for the elderly provided services to them and countered the norm. Following a discussion on the relevance that spiritual needs had on those close to death, the author concludes by contending that there needed to be more emphasis, professionally, on spiritual and psychological considerations during these last stages of a patient’s life (Lieff, 1982). Critical Reflections The article by Jonathan Lieff, Reasons why Doctors fear the elderly, chronic illness, and death, seems to focus its themes on convincing those reading it Doctors from the Western world, especially those from the United States, are not ready when it comes to spiritually and emotionally supporting the needs of those patients who are close to death. The author, further to that, also seeks to argue that training medical practitioners and other health care staff should be trained on spiritual matters during their standard training as a medical and health-training component. The reasons discussed by Lieff that cause fear of those close to death are reflective of spiritual issues, as well as psychological ones, although the article was noticeably lacking any other factors that contributed to the fear of dying patients. The author did offer ideas, which were very persuasive in his quest to explain why medical and other healthcare staff could be in fear of critically ill patients and other terminally ill patients. However, most of the reasons that he used to describe the experiences and attitudes harbored by the doctors did not include any references to other research done on the issue. Neither did the author acknowledge that his statements constituted a personal view of the issue, presumably the experiences, which he had gone through during the course of his profession. One such instance is where the author asserts that, a majority of the doctors did not appreciate the potential of humans to find personal fulfillment through the transcending of physical limitations. Another was that doctors and other healthcare staff did not possess any resources to help them in getting philosophical insights into why death occurs and the process of dying, in addition to, the fact that many doctors were not ready or equipped to handle the impact that religious experiences and beliefs portended on medical treatment’s efficacy. In addition, the author also posits that the society at the time of publishing had made doctors possess a status that was almost priestly (Lieff, 1982). If the author had indicated that the comments he was giving were a matter of personal opinion, rather than his own observations, as well as gone on, to explain his reason, he would have been able to persuade some of the readers who were skeptical of his research findings to agree with him. The author, through giving neither his research findings nor his reasoning on a personal level, potentially increases the resistance of his audience to the arguments, which he asserts in the article. The article contains many statements that are expressive of the author’s frustrations with coming to terms with patients who are close to dying, as well as death itself. For instance, Lieff claims that: Theorists attempt to use the termination of a patient’s life as a stage of psychological development. However, which stages of psychological development lead to a patient dying (Lieff, 1982). Patients and their family members normally turn to their doctors for them to solve their problems…the general medical practitioner is maybe no more ready to deal with the elderly patients under their care…although they are needed to magically give their solutions (Lieff, 1982). In a system, that does not have a spiritual mechanism for decision-making; patients should not die if there are no medical causes for their death. This experience is just one of those ways that the doctor and other healthcare practitioners are left with no help in a system that is not structured to aid them in keeping their feelings in check regarding their helplessness (Lieff, 1982). Statements like the ones above are examples of those, which contributed to the article having an emotional quality that could lead to an increase of the argument’s persuasive quality for some of the article’s readers. However, some readers might think the manner it has been presented is not appropriate for a journal scholarly article. On recognizing that the article has a personal frustration undertone, the article’s audience has a reason to question the author’s objectivity and the overall argument’s validity. This factor, coupled with a general lack of supportive literature or research, has the ability to undermine the benefits that the issues presented by Lieff. Avenues for More Research There were various recommendations that had been made by an earlier research conducted by Kastenbum that were supported by Lieff for the provision of standards that are patient oriented, although he did express some reservations about whether Kastenbum’s recommendations were implementable in the United States. The author also suggests that institutions like hospices, which were not common in the United States by the year 1982 with only roughly one thousand five hundred programs in place by 1990, could provide a model that was satisfactory for caring for patients who are close to death. There are various changes, which have occurred in the United States society that have led to a dramatic alteration of the statuses in place, at the time the author wrote the article. Various pivotal circumstances that affected medical care were: Medicare, in the year 1983, started to pay for elderly care hospice facility stays for those patients who were eligible. The American Psychiatry and Neurology Board approved for official subspecialty Geriatric Psychiatry. The American medical Specialties Board approved in 2006 the Palliative and Hospice subspecialty. Providers of palliative care give treatment for the alleviation of symptoms and pain without any treatment of the causes that underlie their condition. With regards to the National Palliative and Hospice Organization, the number of programs regarding the hospices in 2006, in the United States, had gone up by 3000 to 4500 hospices that catered for an approximated one and half million patients, which constituted of over one third of deaths occurring in the United States in that year as patients were under the care of hospices. These changes were suggestive of the fact that there had been occurrence of a specific shift in the manner in which the medical practitioners and other healthcare providers view patients who are terminally ill and elderly, although they do not indicate to the readers the reason or source for the changes. Lieff’s research as cited requires to be validated again, especially with regards to whether avoidance and behaviors that are prejudicial can still be demonstrated in American medical schools, as well as among medical practitioners and health care providers, as well as psychiatric treatment that is given to patients who are terminally ill and elderly. It would be appropriate also to search for factors other than fear as identified by the author, which might lead to these behaviors and attitudes. The comments made by the author in the article also led to other issues and factors that are suggestive of the fact that other opportunities for research exist. The author notes the therapists and nurses were in the lead as far as the provision of improved care for the terminally ill and elderly patients. The article raises various areas for new research. For example, the manner in which nurses and therapists methods of interaction and treatment with the patients differs from that utilized by physicians. Research could also be carried out with regards to whether they possess different attitudes with regards to patients and their perspectives on dying. In addition, one could choose to study whether the attitudes and methods that they learnt were in a formal setting and how these alternatives were imparted on them. Do these methods have the ability to be transferred to the medical practitioner training, and if they are, what progress has been made in the incorporation of these aspects into medical schools? Finally, one can also research into the reaction of medical practitioners to these methods and what consequences they experience, as well as how this affects their motivation in continuing to use their normal methods. How many medical practitioners are venturing into other subspecialties that are meant to treat terminally ill and elderly patients? The author does not suggest medical practitioners getting increased spiritual training with basis on his assessment on their fears. It would have been appreciable if the author had conducted research into what the current practices at the time were so as to determine whether the assessments that he made were correct as far as today’s medical practitioners are concerned. For instance, whether medical practitioners believe that, in the society, they possess a priestly status; or whether they are morally and ethically ill prepared, whether the requirements for a death certificate leave them feeling that they are helpless, as well as whether the medical practitioners refer the terminally ill and elderly patients to specialists for them to be helped in coping with purpose and meaning problems (Lieff, 1982). Research into the opinions of medical practitioners with regards to integrating spiritual studies into their medical training would help, as well as whether they were supportive of the idea, what ways and methods they would consider as acceptable for the determination of the manner in which the content should be delivered. The article brings up possibilities and issues that have many questions that are worth exploring. More examination should be done quickly into possibilities that add on to those given in this paper. Conclusion The author, in the paper Reasons why Doctors fear the elderly, chronic illness, and death, presents convincing research into the fact that terminally and chronically ill patients require to be offered psychological research. However, in the United States, most medical doctors have shown behaviors of avoidance towards the patients, especially in the late 70s and early 80s. The paper gives the view that the author’s reasoning was meant to persuade readers that there should be the inclusion of spiritual training into training of American doctors. More than thirty years have elapsed since the article was written and significant changes have occurred in this period, in the field of medical psychology, with regards to how terminally and chronically ill patients are treated in the United States. With the increasing number of the elderly and the serious concerns that the author raises, more current research into practices of medical training, as well as the need for appropriate goals to be set to include spiritual training in the curricula for medical education should be conducted. References Lieff, Jonathan. (1982). Eight Reasons why Doctors fear the elderly, chronic illness, and death: The Journal of Transpersonal Psychology, 47-60. Read More