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.
Author(s): Federica Raia, Mario C. Deng, Murray Kwon
Publisher: World Scientific Publishing
Year: 2022
Language: English
Pages: 227
City: Singapore
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
