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Atul Gawande on Respecting Choices®

In a recent conversation with Harvard Divinity School Dean David Hempton, Atul Gawande, CEO of a joint J.P. Morgan-Berkshire Hathaway-Amazon healthcare venture, praised Respecting Choices as the best program for integrating interdisciplinary care delivery teams. A transcript of his comments is below.

David Hempton: Have you had much experience in dealing with hospital chaplains and how do you see their role, what advice might you give to — you know — anyone going into that career, profession in our audience?

Atul Gawande: I have, but I have to say it’s sort of one of those relationships that I think has been handled badly. You know often, the chaplain will come by and ask patients if they would to pray with them and the patients will say ‘yeah’ and then the doctor comes in the room and the chaplain’s expected to scurry away, you know — this comes first and there’s a kind of deference there which reflects a failure to negotiate what does this person need and how do you actually be part of the team — and they’re generally not conceived of as part of the team.

The best place that I’ve seen it done is through a program called Respecting Choices created in Wisconsin — in Gunderson Lutheran Hospital there — and it’s spread now across the country… and they trained chaplains as well as social workers as well as others on how to have these conversations about your goals and priorities besides just living longer, what matters to you in your life and then opened up the channel so that those priorities…. so that they, the chaplain or the social worker or the nurse who’s seeing the patient for many more hours than I am, can be part of articulating what their goals really are, what their priorities really are… oh this person’s trying to get to a wedding of their child and that’s what’s really important to them or they would really love to find some way to get home and go to church or just have someone come pray with them. And we generally have separated those and they aren’t part of the team and I think that’s a real failure and that’s something that has to change.

The Respecting Choices program has been very effective in helping do lots of things. You know, in Wisconsin they’re up to [more than] 80% of people having a living will because of the integration of the chaplains into the medical planning process and they have had, they were one of the first to have people going home on hospice much more regularly. It is the majority of people there, where, as they come to the end of life [they do not] die in the hospital and feel their goals are actually being respected more.

You may view the full conversation here.

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