The Impact of Inappropriate Care with Dr. Gianni D’Egidio, Part 2

Solving Healthcare with Dr. Kwadwo Kyeremanteng

The Impact of Inappropriate Care with Dr. Gianni D’Egidio, Part 2

In part 2 of our tremendous discussion with Dr. Gianni D'Egidio, we dive deeper into the consequences of inappropriate care. Specifically, we talk about how culture affects the aggressiveness of…
September 27, 2019

The Impact of Inappropriate Care with Dr. Gianni D’Egidio, Part 2

Association Between Immigrant Status and End-of-Life Care in Ontario, Canada:

Brain death case:

Resource Optimization Network website:

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Please send your comments/feedback to [email protected]

Episode transcript:

Kwadwo:                             00:01                     Welcome to solving healthcare. I’m Kwadwo Kyeremanteng. I’m an ICU and palliative care physician here in Ottawa and the founder of resource optimization network. We are on a mission to transform healthcare in Canada. I’m going to talk with physicians, nurses, administrators, patients and their families because inefficiencies, overwork and overcrowding affects us all. I believe it’s time for a better healthcare system, best more cost effective, dignified and just for everyone involved.

Kwadwo:                             00:37                     Thanks everybody for joining us on solving healthcare. It’s your host Kwadwo Kyeremanteng. Before joining our second part of the conversation I had with Dr. Gianni D’Egidio, I just wanted to talk about a couple of things. Number one, I have been extremely overwhelmed and grateful for the feedback I’ve received about part one. It’s been mostly from nurses within critical care and, and what they’ve fed back to us is how meaningful it’s been that somebody has been advocating for their concerns. And I gotta tell ya, you know, it really does come from the heart when you see how hard these these guys work to try and improve Karen and get their patients better and functional. And I had this moment a couple days ago. Uh, working in the ICU is like three in the morning and brought down a fairly sick patient and watching everybody moved together and working together to get that patient comfortable, to get that patient set up, to provide speedy, efficient and honestly love and care it, it is truly was magical and sometimes you take for granted what people do.

Kwadwo:                             02:17                     And I, I just wanna I wanted to mention again, these guys are my mini heroes, how hard they work, how excellent they are at their job and it can’t be, can’t be overstated. Um, so I just wanted to mention that real quick. The other thing, uh, was going to mention in terms of any feedback, you could send an [email protected] and you could follow us @Kwadcast on Twitter. Okay. So part two of our conversation with Gianni D’Egidio it’s a good one. I won’t lie to you. We talk about how culture can impact the level of care that is requested. We talk about Gianni’s ability to discharge patients efficiently. We talk about the dangers of dr Google. We all know dr Google seems to know everything, but does he or she, we talk about the perception the media gives on medical care and the villainized nation of physicians. And then we talk about these recent brain death cases. So, so just to clarify, these are cases where patients are declared dead cause they’re brain dead and the family has questioned that diagnosis and and have appealed to the courts for judgment. So without further ado, dr Gianni D’Egidio

Gianni:                                  03:59                     I’ll answer it again. The drive to address these issues to confront families I the dry, where’s it coming from? It is an absolute, I’m absolutely infuriated with the, I guess absurdity of these cases when if you, a rational objective individual would look at this and say this does not make sense. And this brings us into the topic of what is driving this from the substitute decision maker side of things. And these are my comments and some of it supported by evidence. Some of it supported by just my anecdote. The of these 12 individuals in my study, only one was born in Canada. The vast majority of individuals, 11 out of the 12 were not born in Canada. And there was always a religious argument to their, um, request for therapy. And this is similar, not exactly the same, but to a Dr. Fowler study from Toronto looking at individuals who are recent immigrants to Canada.

Gianni:                                  05:06                     We’ll re, we’ll demand, well not demand, but will undergo sociology. Yeah. It’s associated with more aggressive care towards end of life. Right? So there’s a religious cultural factor to it and I’m not being demeaning about that or whatever else, but this brings us into a bigger societal issue of the inability of, of religion to appropriately deal with death. I find, um, if we’re going to, uh, say that physicians are not properly educated and cannot deal with death, I would have to make the exact same argument for religion. Um, there is this consistent argument that life at all costs and despite every single religion saying, Hey, when you die, you’re actually going to go to whatever it may be, let’s say heaven and better place, whatever else. Um, and there’s this consistent argument, which again, if you speak to religious leaders from every associated faith, there’ll be a disagreement about how aggressive to be towards end of life. And I’ve had that because we’re fortunate that at our institution has spiritual care services and some very well respected members of the religious community of all different types of faith who will, who I’ve had the opportunity to discuss this with. And they agree that yes, we don’t need to be this aggressive towards end of life. So that brings up a whole other, like you could do a whole other podcast on, on that. And I’m not gonna get into the sides that

Kwadwo:                             06:28                     that is a, a monster topic. Um, so one thing we haven’t touched on is like how exactly are we going to fix these issues? So we’ve identified that, you know, culturally we, it’s hard to accept death. Uh, we, we see that we could be better communicators, better, better at dealing with advanced care planning, goals of care discussions and so forth. We talked about how conflict manage, like we’re not taught how to manage conflict in medical school and in residency. And fellowship or as even staff really. So where do, where’s the biggest bang for your buck? Where should we, how do we fix this business?

Gianni:                                  07:17                     Um, I guess I’ll, I’ll go back to the points I made earlier about, um, lack of education and then the fear component. Uh, tying it back to those two things in terms of education, we need to be educated on how to confidently propose a treatment plan. And you can’t teach confidence, but you have to be able to reassure individuals. And I try to tell my med students and residents this, that yes, getting sued or getting a complaint absolutely sucks. If you follow the ethical, legal and medical framework of proposing an appropriate treatment plan, you will be absolutely fine. Yes, it’s gonna suck. You’ll get a college complaint, you might get sued, that’s gonna take years of potentially of your life. But there are methods to deal with that. And the vast majority of the time, I think, at least from what I know, you’re going to be absolutely fine in the end, but you have to deal with that.

Gianni:                                  08:12                     Um, and I’m not trying to minimize these issues, but you, you’re going to have to deal with that. And that gets into a system or of a system type of, of issue is why is it as physicians, when we try to do the right thing in these certain cases that we are absolutely going to get punished for it. There has got to be some either new legislation and new policy that will allow us to constrain the treatment options available to an individual and at the same time guarantee that this not, this does not get dragged through the courts or result in complaints or whatever else it may be. Now these are for the extreme cases. Um, but there has to be some sort of change in legislation. And this brings us back to the study that the, about the ethical failings of, of the CPS policy and the health care consent act, those, those two things need to change and they need to be more supportive of other ethical principles. And I’ll be Frank, need to be more supportive of the healthcare teams that are involved because with changing technology and changing, um, demands from the public, this is only gonna get worse unless those two pieces of policy and legislation change.

Kwadwo:                             09:18                     Yeah. I mean like you look at it, you’re going to have more, less engagement by a care teams and less people are gonna want to do this for a living. The longevity of our nurses, allied health decreasing, you’re seeing more physician burnout, you’re seeing more and more physician issues in terms of mental health, wellness and so forth. And then, I don’t want to keep harboring this, but like the financial impact, when you look at the decreasing labor force, when you look at providing care, like it really is defensive medicine. You’re providing care because you’re afraid of the consequences of, of the complaint of you ha or you’re afraid of the consequences of, of being sued. Like it’s a lot, you know, and like, and then in our current environment we end up cutting services that are often most beneficial like social work, physio-therapy spiritual care, like all that stuff is being cut.

Kwadwo:                             10:17                     Meanwhile, we’re just flogging people with care that they don’t even want. It’s insane what you, when we were talking offline a couple of days ago, you were talking about the backlog of, of the system because of all these issues and not being able to provide, for example, care at home, you know, especially near end of life because of the lack of resources I wanted to do to talk about your experience. Like you had, um, your mother-in-law, she passed away at home and maybe you could speak to that experience in and counteract that with what we see most often. Yep. So the,

Gianni:                                  11:05                     I’ll, I’ll speak on my personal experience with, with my mother-in-law and then I’ll speak on the, I guess my professional experience with occasionally delivering end of life care at people’s homes. Um, so for instance, with my, well not only my mother in law, but my, my grandmother in law as well, both, uh, end of life care, both received end of life care at home, um, surrounded by family members in a quiet, peaceful environment, um, with access to physicians, nurses, caregivers. Now the bias in that or the caveat to explain to that as I am a physician obviously and I know what I’m doing when it comes to end of life care and patient care and there are family members of mine who are involved in health care as well, who know how to deal with these things and we’re young and able bodied and able to supplement or give some of the care ourselves as well.

Gianni:                                  12:04                     So not everybody’s going to be able to do that. And that’s completely understandable. However, the experience at home, you can argue, and you and I have, I’ve gone through the literature on this. The vast majority of Canadians want to be at home when it comes to end of life. So the biggest barriers to that are physicians and qualified health care, other qualified healthcare professionals deliver end of life care at home. The equipment that can be set up, the medications can be delivered, all of that can be taken care of. But the access to a physician, the access to that healthcare team that has to provide that end of life care is going to be limited. Right. Especially if you look at other individuals who are not capable of delivering that care of themselves, whether it be from a lack of knowledge or lack of the able bodies to do that.

Gianni:                                  12:46                     Um, those two experiences at home I felt went very well. Um, and the, from a professional aspect, occasionally I’ve been involved with delivering end of life care at people’s homes at their request. Um, and I’ve, I’ve delivered and I feel that I am capable in delivering palliative care in the hospital setting and in these situations, um, patients and or their loved ones asked me to be involved at home because there was no physician available. Um, actually during the summer, most of the time was during summertime months. When are extremely overworked and wonderful community palliative care physicians are on vacation, not available. Um, so I agreed to do end of life care at home in those individuals home. And it went, I think, again, based on the feedback I received from family members and my own sort of interpretation of it went very, very well. Um, compared to a hospital setting where, let’s be honest, the hospital setting is loud, incredibly loud, incredibly disturbing.

Gianni:                                  13:47                     Um, you’ve got overhead announcements almost constantly. The fire alarm goes off, what would you say? Every day, every two days there’s a fire alarm going off almost every day. There’s some sort of of alarm going off and it’s cold. It is unfamiliar and unfortunately, because of how backlog the system in is, you are sharing a room with other individuals who are potentially screaming, agitated, noisy because of no fault of their own, again, because of their medical condition, in my opinion. That’s just my opinion. That is a very, very poor way to spend your last few days of life. Um, and the, because of our hospital system, the, there’s complete lack of private rooms now, ideally when we build our new hospital that that will not be an issue. But the dying in, in a ward room with three other patients beside you, I, especially when they’re, when they’re profoundly agitated is I think just terrible. So that’s my sort of professional and personal use of, of end of life care at home.

Kwadwo:                             14:53                     Yeah. And, um, I mean obviously as a palliative care doc, I, I’ve seen all sides. I couldn’t agree more like that experience at home surrounded by loved ones in their own environment compared to that potentially dis disruptive environment in hospital. Like it’s still good but it just could be better. Once again, kind of switching gears a little bit, I don’t like to give you too many compliments for obvious reasons, but we both know I look incredibly sexy. Do not know you guys. Gotta listen to this. He is wearing everything tight. Okay. And the reason I’m not drinking or eating anything is because I don’t want you all to hear me vomit on air. Okay. Um, I’m very uncomfortable in this car. Terrible by the way. Terrible. Thank you so much. Um, so getting back to the real deal, you are talented. Maybe that’s the wrong word.

Kwadwo:                             15:59                     You seem to have an ability, you have an ability to see, to discharge patients probably quicker or more efficiently than some of your colleagues. And I want you to speak to like what are you doing that others aren’t? Because I think this is another thing that could be scaled in terms of like improving the backlog of patients in emerge. Like when I got off a couple of days ago at the hospital I was at, I think there was about 20 inpatients in occupying a merge bets. You know what I’m saying? So like what is the, what’s the ticket? What are you doing that so that people aren’t doing

Gianni:                                  16:41                     [inaudible] three things. One is, um, I think my colleagues or our healthcare teams don’t understand that the vast majority of tests and care can be delivered as an outpatient would be the first point. The second point would be that, again, a lot of people don’t understand that long term care facilities can actually deliver very good and um, can deliver antibiotics and oxygen. So that will prevent an admission or ongoing admission for, um, residents of longterm care facilities. And third, and I’ll get into this, I give out my cell phone number, which sounds crazy and we’ll talk about that in a sec. It is crazy. First getting back to, um, triage of tests. I can’t tell you how many times I’ve had patients that I’ll take over a team and my residents or someone will be like, they’re waiting for a CT scan for their chest before they can be discharged home.

Gianni:                                  17:39                     Yet patient is walking around eating, talking perfectly fine, but are waiting three or four days on hospital for a test when they can get that test in five or six days as an outpatient or a week or two from now and won’t change the ultimate outcome. So I think an example like that is less. Same thing with ultrasonography, a blood work, whatever it may be. It can be managed as an outpatient. And more importantly, especially if set individual has a family physician communication with that family physician and ensuring the appropriate followup tests can be done. But it takes a tremendous amount of work to do it as far easier to keep someone in hospital and just do it yourself than it is to coordinate all the care as an outpatient, which again gets us, gets into a system. Issue number two, the long term care facility, uh, issue or, um, lack of knowledge of what they can provide.

Gianni:                                  18:30                     Oxygen can be provided at longterm care facilities more times than not. The classic example is I get, uh, an elderly individual from a longterm care facility who presents with a pneumonia. They’re on two, three liters of oxygen. You take off the oxygen, they de saturate to 85% or 80% or whatever it may be. And the team overnight has admitted this patient because they require oxygen. While the team overnight doesn’t realize that that long term care facility they came from can actually provide oxygen. They can actually provide intravenous antibiotics through coordination if it’s even required. And the vast majority of time, intravenous antibiotics are actually not required. So you can get away with an oral antibiotic. You can get away again with an, seems a little bit cruel, but an intramuscular antibiotic if an intravenous route is truly needed. And this brings me into the whole point of what we were talking about earlier, is the whole goals of care conversation as well.

Gianni:                                  19:17                     Um, so an individual advanced age with multiple comorbidities who comes from a longterm care facility. The first thing I will do is have a discussion with the substitute decision makers about where are we headed with this care and what are their expectations and what are the treatment goals in this situation and I can’t tell you how many times that the substitute decision maker when I approached them with a treatment plan of palliative care or no further transfer to hospital basically tells me thank you for having that conversation with us. We’ve been thinking that the whole time, but we just haven’t had that opportunity to discuss this and thank you. And then I established that we’re going to send them back to their long term care facility with a different type of treatment plan. Fair enough. So that, that’s point number two. Point number three again, in terms of coordination of followup tests and whatever else, I give my phone number to individuals to call me when their tests are done or to ensure that their tests have been scheduled and whatever else. And you’re kind of looking at me like I’m [inaudible].

Kwadwo:                             20:13                     I do think you’re crazy. There was zero chance I would give a patient or family member, my Sally, you know what I mean? Just like I get even from friends alone, I get text message or their kids P to see what would this a asking me to figure out what’s going on with this. And I can’t imagine giving my cell phone to all the patients that we see. And the, the amount of over use I guess in terms of this is nothing not supported by any evidence

Gianni:                                  20:48                     except my own anecdote and my own experience in that 10 years or so, 10 or so years that I’ve been doing this, I’ve only had to tell one individual to stop calling me a because the calls were, were inappropriate. Uh, video was me. So, um, I will, I will say that the, even when I give the instruction, I will tell them face to face. I’ll write down the instruction and their discharge plan to call me on Tuesday or Wednesday or whatever day it may be to follow up on how they’re doing. I will say a good 75% do not follow those instructions. So the vast majority people don’t even call me. Um, those 25% who do call me great. I followup on their blood work and I would say about five to 10% of the time we actually catch something or require that they be readmitted to hospital or something needed to be done.

Gianni:                                  21:38                     Um, so that has helped, uh, tremendously, uh, in coordinating their care. Whether it prevents hospital admissions, I’m not entirely certain. I think it does. Um, what I would say is it probably prevents emergency room visits, especially in the individual who doesn’t have a family doctor. Um, cause they can call me with followup tests and whatever else. I mean, where you’re throwing down make sense like you’ve ever thought about doing your office number or you problem with office number is completely inefficient. Right. So, um, they’ll call my office, my admin assistant may not be there or they may give the, they’ll leave a voicemail and the phone number or the name is hard to decipher, um, or they’re going to be calling after hours. Right. Um, something may be going on at seven or eight o’clock at night and yes, I’ll have my cell phone on there.

Gianni:                                  22:26                     Yes. Uh, with me, uh, yes, I will answer it the vast majority of the time, but it cuts down on all that. Um, I guess phone tag, which I find can be very infuriating sometimes. Um, so from an office perspective, again, everybody’s practice is a little bit different. I would prefer they just call me directly, um, because spelling of names, phone numbers that they leave, whatever it may be and that my admin assistance, there’s no way they know of all the patients that I’m dealing with. That’s not how my practice is set up so. Well, Gianni,

Gianni:                                  22:59                     anything else you wanted to add or comment on in terms of whether that’s solutions or problems that you’re, that you’ve been exposed to? [inaudible] I’ll make these comments and sort of a, a analogy, a passenger on an airplane would never tell a pilot how to do his job. Even if they had all the information available. Let’s say you were in the cockpit, the door was open and whatever else and you could look into the cockpit and you have all this information from you and you had direct access to a pilot. You would never tell the pilot, I want you to fly this way cause I want to get there faster or I want you to land over here or whatever it may be. Okay.

Speaker 5:                           22:59                     

Gianni:                                  23:39                     you can argue that medicine and not to put down pilots, but medicine is far more um, challenging and requires far more training than a pilot. Okay. Yet every single day that I am in the intensive care unit or on my internal medicine wards, I have a family member telling me what to do.

Kwadwo:                             23:58                     Where is this coming from? I mean obviously I’m experiencing the same thing and it is draining because yes, I don’t mind being questioned. I don’t mind asking people asking me for further explanation in terms of why my treatment plan is the way it is. But the amount of time spent to explain why what you’re suggesting is not beneficial

Gianni:                                  24:25                     or even nonsensical is like getting worse with time. Like it’s like half my day. You have to, again, this, this, we’ll start going on rants here, but this is the problem. They are receiving their medical education from television, movies and Google. So if you type into Google, um, or let’s, let’s use the example of CPR. I can’t tell you how many times I’ve been screaming at the television watching Grey’s anatomy or Chicago hope or ER or whatever. Toby, lot of Grey’s anatomy watch tons of it. Yeah. So the or any movie for instance that someone is getting operated on. I saw a guy in one show, I can’t remember which show, who has a ruptured aortic aneurysm, who’s being operated on from a surgeon who’s not even a vascular surgeon. And that individual is not even intubated. They don’t even have a breathing tube in.

Gianni:                                  25:19                     So I’ve got news for you people, if you’re going to have major abdominal or vascular surgery, you would require a breathing tube inserted in your mouth. This is a subtle thing that a physician would pick up on, but it’s completely, completely unrealistic. That patient would be dead. That would never happen. Right? That. So people are getting their information from, like I said, from television, that is completely unrealistic. And Google has now allowed you to access a wealth of information. However, the ability to tease down that wealth of information to what is credible and what is not credible. That’s where your training comes in. I had a patient asked me the other day, I want STEM cells for my loved one to repair his brain. I read it on the internet. I read it on Google. I’m not kidding. This is not made up. I want STEM cells to cure his massive stroke. I Googled it. It exists. I want it. That was literally the conversation.

Kwadwo:                             26:17                     Yeah. And it’s, and it’s not going anywhere. It’s gonna get worse. And this is the thing that I’m, I don’t know how to deal with this in any other way except for constant education, constant conversations, explaining why. And to be honest with you, even sometimes that doesn’t work. No. They’ll still insist on you ordering that pet or whatever tests is not indicated. And it comes down to like we’re, for lack of a better word, that coward or cowardliness of of of physicians, we will, lot of us will order the tests and it comes down to being defensive because we don’t want to be named in that complaint. We don’t want to, if we point 0.006% chance that they might be right, you know you’re, you’re too fearful.

Gianni:                                  27:12                     No they will. They won’t be. I’ll, I’ll challenge you on that. They’re not going to be right. These are situations where we all know we can do another CT scan, we can do another MRI. It is not going to change a single thing. All it is done is allowed you as that as that treatment physician that the, or excuse me, attending physician to avoid that difficult conversation which would take half an hour to an hour to do, let’s be honest, it take half an hour to an hour of your time. It’s going to be emotionally exhausting in order to explain why I’m not doing an MRI. It is far easier and takes five seconds to do on my computer right now to order an MRI for that patient. It is way easier to do that than to have that conversation to say, no, I am not doing the MRI. I’ve explained it to you time and time again, I’m not explaining it again and I know this sounds cold and it sounds callous, but I have spent hours and hours with substitute decision makers explaining why we will not do something and the information will not sink in and you cannot tell me that I’m not communicating clearly because there are other members of the healthcare team there.

Gianni:                                  28:12                     There are social workers, there are nurses, there are residents, there are med students who have all had this conversation and like I said, I’ve had this conversation

Kwadwo:                             28:21                     five or six times previously

Gianni:                                  28:23                     and eventually we just have to say no and it might result in a complaint. It might result in whatever it may be, but we just have to live with it. The right thing to do for everyone’s sake, other patients, society, that patient, that substitute decision maker is to say no. In those situations.

Kwadwo:                             28:38                     I mean, just think about the potential consequences. Even like think about the MRI example in our world, they might need to be sedated for it. They might need to be having a endotracheal tube put in place to have the procedure done. You might have a false positive, you might get a result which is, which looks like it’s something, but it’s essentially not that you then have to chase down. Meanwhile that is, that’s cost. The system will say one to $2,000 literally for nothing because, uh, because of, uh, dr Google because of curiosity, because of anxiety, it has all these downstream effects and it’s, it’s got to stop. And I actually think we’ve talked about this on offline a bit in medical school. Think about how valuable it would be to have, whether it’s conflict, uh, what’s the term? Conflict management, uh, conflict resolution, resolution training to have like expert advice in terms of how to deal with these circumstances.

Kwadwo:                             29:43                     This would go such a long way and it’s like that little nudge that would have so many downstream implications and an improvement. Like you said, you’re getting this advice from usually your, your colleagues and who knows how good they are at managing this. So yeah, man, like it’s, and it’s, I don’t think it’s that hard. You know what I mean? I, I know we get offered conflict resolution training through a R like Canadian medical association, but really if we’re talking about creating some legit change, you know, investing that that little bit of investment could have such incredible downstream improvement.

Gianni:                                  30:28                     And I mean, if I can make one last point about getting into what are some of the problems out there, and again, this is ranting, but in all the cases that I’ve been involved in that have gone to either that I’ve been named or indirectly referred to in the media, the vast, all the stories that have been written about these cases have been inaccurate. And that is another source of, I think, what the public will read and take into things. And there’s almost this recently I would say, and this again is my opinion a villainization of the healthcare teams. It’s crazy. Doctor wants to pull a plug, doctor wants to do this. Um, my loved one is a fighter they’re gonna pull through with the doctor, said they were going to die, blah, blah blah. And they’re, I think one of the things that we need to get better at as physicians and hospitals is actually commenting on these cases once it’s been brought into the public Ave.

Gianni:                                  31:20                     not again disclosing any personal health information, but we can comment on such things as why we are doing what we are doing. Um, and I can’t tell you how many times we work in an intensive care unit. Patient critically injured in car accident. Well, no, the patient isn’t critically injured. I’m in the intensive care unit right now. I’ve got news for you. I’ve been working in the quadrant or any tertiary or excuse me, quaternary trauma unit or intensive care unit. That patient is not in the intensive care unit. In fact, that patient is, I would want to say perfectly fine, but from a relative perspective of being critically injured, they’re not, they are actually perfectly fine in the trauma unit or not even in the trauma unit. So there’s just a small example of the sensei, slight sensationalization in the media and it’s incorrect. That label is incorrect. They’re not critically injured.

Kwadwo:                             32:07                     Yeah. I don’t know where this Ville villainization is coming from. And I spoke to this a little bit earlier, like we got into this game to help people get better. We don’t have agendas, we don’t have, we just want to get that patient back to where they were and there is this insane amount of this doctor acts, he’s making too much money. This doctor X wants to pull the plug. Even like some of these cases, the brain death patients,

Gianni:                                  32:40                     I dunno, I, I mean I’ll full disclosure didn’t read the articles that while I’ve read, I’ve read all of them. Should we even get into this? We don’t want have to, this is five minutes, five minutes on the [inaudible]

Kwadwo:                             32:49                     brain does stuff cat getting back to like the, you know, in terms of like dr Google or like an unrealistic expectations, these brain death cases, I don’t know what to say. I feel like it’s insane what’s going on.

Gianni:                                  33:08                     And again, this is a, it falls into education where someone cannot understand that a brain is dead, but the rest of the body is working for a physician. This is very straightforward. Your heart is basically autonomous. It really, for the lack of better purpose doesn’t really depend on your brain, right? Right. Your sinus node is going to generate an electrical current that is going to make your heartbeat, doesn’t require a living circulating blood in your brain. Um, whereas the public doesn’t understand that public thinks death is K my heart is stopped. I am dead at that point. Uh, they cannot understand the concept that there is zero blood flow to the brain and that entire brain is dead based on imaging. Uh, we can prove it through, you know, of all the tests that we can do through the clinical exam that we can do.

Gianni:                                  33:57                     And yet, um, they cannot, um, deal with that fact first of all, understand that fact. And then if they do understand that fact, they don’t want to deal with the fact, um, that, um, that patient is dead. And in all of these cases there has been the, again going back to the religious concept of it, uh, they will say that our religion dictates that this patient is not dead until their heart stops. That is a very dangerous Avenue to go down. Would the same religion deny or claim that while I don’t believe they have metastatic lung cancer, our religion dictates that. I don’t believe they have metastatic lung cancer. It’s the same diagnosis. The diagnosis is a diagnosis. It’s medically proven. How we can allow a religion to dictate death or a diagnosis is a very, very dangerous concept and something that needs to be dealt with at a legislative level, at a government level where there has to be clear legislation that this is death. This is medically proven, it is there. This will not be debated. This is required.

Kwadwo:                             35:00                     It’s time like the resources, the stream on the, on the healthcare team, and actually I would argue the stranger putting the family through to like, I don’t know, even if they’re saying this stuff, they’re going to go through some emotional roller coaster thinking that loved one acts is not dead. They’re just, whether it’s a care team,

Gianni:                                  35:21                     I will have to say trust or whatever. Shame on the, on the legal system for even entertaining this. And someone will argue, while this has no public health ramifications, of course it does. The cost associated with this, and this was mentioned, the reasons for decision and then the kitty case, the associated with this is tremendous. That is a public health concern right there because there is no way in our society that we would allow our religion to dictate whether or not you have pulmonary tuberculosis. We would isolate you, quarantine you, treat you despite what your religious views may be because of the public health concern that is there. And again, people will, some people may hear this and say, well, doctor the GTO, he’s, he’s an extremist. Um, and these are, these are insane views. They’re not insane views in the eyes of, of the health care consent act.

Gianni:                                  36:06                     A treatment is a treatment or a diagnosis is a diagnosis. It does not change. It cannot be influenced by religious beliefs, right? So that that needs to be dealt with and needs to be dealt with quickly. Uh, however it will not be. This will take I suspect, years to resolve. Yeah. And it’s, it really is too bad. Listen, I want to thank you for joining the podcast who was, uh, this was the inaugural one and, uh, I couldn’t think of a better person kinda to, to join me and, and to talk about these things and I really appreciate that. And uh, how do people get ahold of you if they want to get a hold of you? My cell phone. I’m just no way.

Speaker 6:                           36:46                     Yeah. One 900. Um, but yeah, no, seriously, thanks for joining us and uh, and thanks for doing this anytime. My pleasure.

Kwadwo:                             36:59                     Once again, thanks so much for listening to our conversation with Gianni. Did Judaeo in terms of takeaways from a system level or from an administrative level, lawmakers need to provide clinicians with that safety or the tools to be able to do the right thing, to feel safe, to say no to care. That is not beneficial from a clinician perspective. Address goals of care early. Don’t shy away from these conversations and suggest a treatment plan that you feel is appropriate. And in terms of the general public, what, what can you do? Don’t shy away from those conversations about end of life. You know, we’re all gonna die one day. And to have those conversations and to plan ahead and to know what your loved one will want will go a long way. I promise you that. All right, for those once again, don’t want to leave some comments. You could email us at [email protected] that’s [email protected] you can follow us on Twitter @kwadcast and a subscribe today cause it could be more goodness to come freshness all around y’all. All right, talk to you soon.


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