PubMed · 13680889
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M ABADI. [On death. Psychoanalytic notes on a basic fantasy].. https://pubmed.ncbi.nlm.nih.gov/13680889/
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BACKGROUND AND OBJECTIVE: German hospices are subject to a special law on homes. This makes sure that patients' medicine is stored individually. It has to be immediately destroyed when they have died and is not allowed to be used for other patients. This is controlled by a public authority for narcotics. We interviewed German hospices by questionnaire to find out how they deal with this problem. METHODS: A questionnaire with ten items about the care situation and pain therapy was sent to all adult hospices. RESULTS: Of the 101 hospices approached, 54 replied. On average 101 guests were cared for per hospice in 2003, and the average duration was 23 days; 49% used an official solution in accordance with the relevant authorities and 87% an unofficial solution. In 32 (59%) pain measurement was documented by a pain scale (VAS), 67% used a general documentation, and in one case pain measurement was not documented at all. DISCUSSION: Even if 49% of the hospices used an official regulation, 87% used an internal solution. This is economically understandable because the cost of destroyed medicine is estimated at more than 100 Euro/patient. Delayed treatment causing intense pain can occur due to incorrect keeping of medicine pools. Destroying medicine is inconsistent with an economic framework. CONCLUSION: In compliance with a comprehensible documentation and with the consent of the client or heir, the passing on of medicine should be made possible. The Ministry of Health from NRW is in agreement with this.
This paper examines routine primary care consultations in the UK where smoking is discussed using data from a larger study of the factors influencing discussion of smoking between general practitioners (GPs) and patients. In this study, consultations have been analysed with a focus on the termination of discussion about smoking, using an approach that is informed by the conversation analytic (CA) literature on professional/client interaction. In interviews from the previous larger study, GPs suggested two main reasons for not pursuing discussion of smoking in consultations. One reason was an overarching fear of damaging the GP/patient relationship. The second reason related to clinical judgement, where it was feared that an attempt to stop smoking might exacerbate a patient's existing condition, particularly their mental health. This paper suggests that, while this latter scenario of clinical judgement is borne out by the consultation data, there are two more subtle patient behaviours which are associated with GPs abandoning further discussion of smoking: patients' 'troubles telling', where the issue of smoking is de-emphasised in the face of other 'troubles', and 'defensive expansion', where the patient over-emphasises deficiencies to curtail discussion. Greater awareness of the situations in which doctors end discussion of smoking will help GPs to develop ideas for alternative approaches in these circumstances which could result in more meaningful, effective engagement between doctors and their patients who smoke when smoking is discussed.